Routine Surveillance for Bloodstream Infections in a Pediatric Hematopoietic Stem Cell Transplant Cohort: Do Patients Benefit?

Abstract

The present study suggests that BSI surveillance in children following HSCT engraftment has a very low yield and significant cost. It is unclear whether it contributes to improved patient outcomes.

Utility of routine surveillance blood cultures in asymptomatic allogeneic hematopoietic stem cell transplant recipients with indwelling central venous catheters at a comprehensive cancer center

“…A comprehensive literature search revealed only 2 published studies, both in pediatric patients, that examined the utility of obtaining SBCs in asymptomatic HCT recipients (Table 3). 25,26 These studies reported the frequency of clinically significant cultures to be between 0.5% and 7%. However, the sample size for both studies was smaller than ours, and 1 study 25 included only 1 SBC per patient, performed prior to the transplant.…”

“…The overall distribution of organisms isolated in our study was similar to the 2 articles previously cited. 25,26 Most of the positive cultures (81%) had low colony counts of organisms of questionable and low clinical significance (eg, coagulase negative staphylococci, Corynebacterium spp, other common skin inhabitants). However, the organisms isolated from SBCs of patients in group 3 included gram-positive isolates (48%) (eg, viridans group streptococci, methicillin-resistant S aureus, Enterococcus spp, including vancomycin-resistant strains); gramnegative isolates (32%) (eg, Acinetobacter spp, Klebsiella spp, Pseudomonas spp); and various other organisms (eg, Nocardia spp, Candida spp, Mycobacterium mucogenicum).…”

“…23,24 However, SBCs are not recommended in the absence of clinical signs and symptoms in immunocompetent individuals, and their utility has been questioned in some studies conducted in pediatric HCT recipients, especially those without neutropenia. 25,26 Currently, no guidelines exist for the management of asymptomatic patients with positive SBCs. Because the practice of obtaining SBCs has become a standard of care at many institutions, including ours, we conducted a retrospective study to determine the frequency and clinical significance of positive SBCs and whether or not they are useful in predicting subsequent BSI.…”

“…Comparison of previous studies25,26 examining the utility of SBCs from asymptomatic HCT recipients with the current study HCT, hematopoietic stem cell transplant; SBC, surveillance blood culture.…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…59 Similarly, small case series of weekly BSI surveillance in asymptomatic children undergoing HCT demonstrated very low yield and significant cost, with no clear improvement in patient outcomes and higher rates of detection of contaminants. 60,61 Taken together, the published literature do not support the utility of surveillance blood cultures in HCT.…”