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Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017).

Publication ,  Journal Article
Heston, SM; Young, RR; Hong, H; Akinboyo, IC; Tanaka, JS; Martin, PL; Vinesett, R; Jenkins, K; McGill, LE; Hazen, KC; Seed, PC; Kelly, MS
Published in: Open Forum Infect Dis
November 2020

BACKGROUND: Bloodstream infections (BSIs) occur frequently after hematopoietic stem cell transplantation (HSCT). We examined the microbiology of BSI in pediatric HSCT recipients over a 2-decade period at our institution to inform empirical antimicrobial prescribing and infection prevention strategies. METHODS: We conducted a retrospective cohort study of children (<18 years) who underwent HSCT at Duke University between 1997 and 2015. We used recurrent-event gap-time Cox proportional hazards models to determine the hazards of all-cause and cause-specific BSI according to HSCT year. We compared the median time to BSI by causative organism type and evaluated for temporal trends in the prevalence of antibiotic resistance among causative organisms. RESULTS: A total of 865 BSI occurred in 1311 children, including 412 (48%) Gram-positive bacterial, 196 (23%) Gram-negative bacterial, 56 (6%) fungal, 23 (3%) mycobacterial, and 178 (21%) polymicrobial BSI. The hazard of all BSIs did not change substantially over time during the study period, but the hazard of fungal BSIs declined over time during the study period (P = .04). Most fungal BSIs (82%) occurred in the first 100 days after HSCT, whereas mycobacterial BSIs occurred later after HSCT than BSIs caused by other organisms (P < .0001). The prevalence of vancomycin resistance among BSIs caused by Enterococcus faecium increased during the study period (P = .0007). The risk of 2-year mortality in children was increased with BSI (P = .02), Gram-negative bacterial BSI (P = .02), and fungal BSI (P < .0001). CONCLUSIONS: Despite expanded practices for BSI prevention over the past several decades, the incidence of BSI remains high in pediatric HSCT recipients at our institution. Additional strategies are urgently needed to effectively prevent BSIs in this high-risk population.

Duke Scholars

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

November 2020

Volume

7

Issue

11

Start / End Page

ofaa465

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Heston, S. M., Young, R. R., Hong, H., Akinboyo, I. C., Tanaka, J. S., Martin, P. L., … Kelly, M. S. (2020). Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017). Open Forum Infect Dis, 7(11), ofaa465. https://doi.org/10.1093/ofid/ofaa465
Heston, Sarah M., Rebecca R. Young, Hwanhee Hong, Ibukunoluwa C. Akinboyo, John S. Tanaka, Paul L. Martin, Richard Vinesett, et al. “Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017).Open Forum Infect Dis 7, no. 11 (November 2020): ofaa465. https://doi.org/10.1093/ofid/ofaa465.
Heston SM, Young RR, Hong H, Akinboyo IC, Tanaka JS, Martin PL, et al. Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017). Open Forum Infect Dis. 2020 Nov;7(11):ofaa465.
Heston, Sarah M., et al. “Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017).Open Forum Infect Dis, vol. 7, no. 11, Nov. 2020, p. ofaa465. Pubmed, doi:10.1093/ofid/ofaa465.
Heston SM, Young RR, Hong H, Akinboyo IC, Tanaka JS, Martin PL, Vinesett R, Jenkins K, McGill LE, Hazen KC, Seed PC, Kelly MS. Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997-2017). Open Forum Infect Dis. 2020 Nov;7(11):ofaa465.
Journal cover image

Published In

Open Forum Infect Dis

DOI

ISSN

2328-8957

Publication Date

November 2020

Volume

7

Issue

11

Start / End Page

ofaa465

Location

United States

Related Subject Headings

  • 3207 Medical microbiology
  • 3202 Clinical sciences