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

Abstract

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.

The gut microbiome in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

“…Although transplant-related mortality could generally be considered lower when compared to adults, HSCT complications, such as GvHD and bloodstream infections (BSI), affect a high proportion of patients. [4][5][6] While there is considerable evidence about this topic in adult HSCT, less is available in the pediatric setting. This particular population offers interesting challenges such as dealing with a rapidly and continuously evolving GM community and the strong impact of complications in growing subjects.…”

“…For children, HSCT is the mainstay of treatment of several hematological, oncological, and metabolic diseases. Although transplant‐related mortality could generally be considered lower when compared to adults, HSCT complications, such as GvHD and bloodstream infections (BSI), affect a high proportion of patients 4–6 . While there is considerable evidence about this topic in adult HSCT, less is available in the pediatric setting.…”

Alcohol-impregnated caps and ambulatory central-line–associated bloodstream infections (CLABSIs): A randomized clinical trial

“…Externalized catheters make up only a small proportion of ambulatory catheters in this population and may represent a underlying diagnosis that requires more intensive chemotherapy and care. 4,17 Our findings may reflect unique challenges to ambulatory CLABSI prevention, including the relatively uncontrolled home environment compared to the hospital environment, as well as the skill level of central-line caretakers, namely patients and families compared to nurses and doctors.…”

Levofloxacin Versus Ciprofloxacin-Based Prophylaxis during the Pre-Engraftment Phase in Allogeneic Hematopoietic Stem Cell Transplant Pediatric Recipients: A Single-Center Retrospective Matched Analysis

“…The incidence of BSI in pediatric HSCT recipients is reported, in the literature, between 20% and 44% [ 5 ]. Approximately 40% of all BSI are related to at least one adverse outcome, constituting a significant burden to the pediatric HSCT population [ 6 ]. The BSI-associated mortality rate ranges from <5% in the case of Gram-positive bacteria to 40% in the case of multidrug-resistant (MDR) Pseudomonas aeruginosa and 64% in carbapenem-resistant Klebsiella pneumoniae infections [ 7 , 8 , 9 ].…”