A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur, Aditya H.; Bundy, David G.; Werner, Eric; Hord, Jeffrey D.; Miller, Marlene R.; Li, Tang; Lawlor, John; Billett, Amy L.

doi:10.1017/ice.2017.57

Cited by 22 publications

(23 citation statements)

References 23 publications

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“…Among paediatric haematology patients, MBI-LCBI rates represented 43% of total CLABSI rates. This finding is in concurrence with the results of another large study that evaluated 1100 episodes of CLABSI in 34 paediatric haematologic centres between 2013 and 2015 and found that 51% of CLABSIs were classified as MBI [22]. This underscores the importance of preventing MBI-LCBI in this vulnerable group of patients.…”

Section: Discussionsupporting

confidence: 86%

Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece

Kouni

Τσολιά

Roilides

et al. 2019

Journal of Hospital Infection

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Section: Discussionsupporting

confidence: 86%

Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece

Kouni

Τσολιά

Roilides

et al. 2019

Journal of Hospital Infection

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“…Starting November of 2009, the Children's Hospital Association, working with healthcare providers from across the United States, developed a quality improvement network called the Childhood Cancer and Blood Disorder Network that focused on eliminating CLABSI in inpatient PHO and HSCT patients. Starting in 2011, this network started tracking all BSI as per the NHSN definition . Thirty‐two centers participated in the Childhood Cancer and Blood Disorder Network during the study period .…”

Section: Methodsmentioning

confidence: 99%

“…The initiative decreased reimbursement rates for preventable conditions, which included central line–associated bloodstream infections (CLABSI) . BSI occurring in hospitalized patients (day of hospitalization ≥ 3) with a central venous catheter are classified by the National Health Safety Network (NHSN) as either a primary laboratory‐confirmed bloodstream infection (CLABSI), secondary BSI, or a common commensal single‐positive blood culture (SPBC) which are often referred to as contaminents . To address nonpreventable BSI thought to occur from translocation of bacteria through a damaged mucosa, in 2015 the NHSN adopted a subclassification of CLABSI defined a new category of infection termed mucosal barrier injury laboratory‐confirmed bloodstream infection (MBI‐LCBI) .…”

Section: Introductionmentioning

confidence: 99%

“…12 are often referred to as contaminents. 2,5,13 To address nonpreventable BSI thought to occur from translocation of bacteria through a damaged mucosa, in 2015 the NHSN adopted a subclassification of CLABSI defined a new category of infection termed mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). 5,6 The NHSN classification of BSI is somewhat complicated, relying on multiple variables including type of organism, secondary site-specific cultures or imaging, absolute neutrophil count (ANC) at the time of infection, and presence of gastrointestinal graft-versus-host disease (GVHD) with associated diarrhea.…”

Section: Introductionmentioning

confidence: 99%

“…14 We have previously made a case that tracking all BSI, not just CLABSI, in PHO and HSCT patients is a patient-centered, clinically relevant approach that could help better assess across-center and withincenter differences in infection rates. 13 This includes tracking not only CLABSI (stratified by MBI-LCBI vs non-MBI-LCBI) and secondary BSI, but also SPBC with NHSN-defined common commensals. The inclusion of SPBC is relevant since these can be real BSI in immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

Dandoy

Kelley

Gaur

et al. 2019

Pediatric Blood & Cancer

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Background Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all‐cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results Nine hundred fifty‐seven BSI were included in the analysis. Three hundred fifty‐four BSI (37%) were associated with at least one adverse outcome. All‐cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2‐10). Twenty‐one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

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Evaluation of Plasma Microbial Cell-Free DNA Sequencing to Predict Bloodstream Infection in Pediatric Patients With Relapsed or Refractory Cancer

et al. 2020

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IMPORTANCE Bloodstream infection (BSI) is a common, life-threatening complication of treatment for cancer. Predicting BSI before onset of clinical symptoms would enable preemptive therapy, but there is no reliable screening test. OBJECTIVE To estimate sensitivity and specificity of plasma microbial cell-free DNA sequencing (mcfDNA-seq) for predicting BSI in patients at high risk of life-threatening infection. DESIGN, SETTING, AND PARTICIPANTSA prospective pilot cohort study of mcfDNA-seq for predicting BSI in pediatric patients (<25 years of age) with relapsed or refractory cancers at St Jude Children's Research Hospital, a specialist quaternary pediatric hematology-oncology referral center. Remnant clinical blood samples were collected during chemotherapy and hematopoietic cell transplantation. Samples collected during the 7 days before and at onset of BSI episodes, along with negative control samples from study participants, underwent blinded testing using a mcfDNA-seq test in a Clinical Laboratory Improvement Amendments/College of American Pathologists-approved laboratory. MAIN OUTCOMES AND MEASURESThe primary outcomes were sensitivity of mcfDNA-seq for detecting a BSI pathogen during the 3 days before BSI onset and specificity of mcfDNA-seq in the absence of fever or infection in the preceding or subsequent 7 days. RESULTS Between August 9, 2017, and June 4, 2018, 47 participants (27 [57%] male; median age [IQR], 10 [5-14] years) were enrolled; 19 BSI episodes occurred in 12 participants, and predictive samples were available for 16 episodes, including 15 bacterial BSI episodes. In the 3 days before the onset of infection, predictive sensitivity of mcfDNA-seq was 75% for all BSIs (12 of 16; 95% CI, 51%-90%) and 80% (12 of 15; 95% CI, 55%-93%) for bacterial BSIs. The specificity of mcfDNA-seq, evaluated on 33 negative control samples from enrolled participants, was 82% (27 of 33; 95% CI, 66%-91%) for any bacterial or fungal organism and 91% (30 of 33; 95% CI, 76%-97%) for any common BSI pathogen, and the concentration of pathogen DNA was lower in control than predictive samples. CONCLUSIONS AND RELEVANCEA clinically relevant pathogen can be identified by mcfDNA-seq days before the onset of BSI in a majority of episodes, potentially enabling preemptive treatment. Clinical application appears feasible pending further study. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03226158JAMA Oncol.

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A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Cited by 22 publications

References 23 publications

Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece

Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece

Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

Evaluation of Plasma Microbial Cell-Free DNA Sequencing to Predict Bloodstream Infection in Pediatric Patients With Relapsed or Refractory Cancer

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