Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients.
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Background:Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-associated bloodstream infections (HA-BSIs). This study aimed to describe the incidence, microbiology, and risk factors for HA-BSI in pediatric HSCT recipients. Methods:We performed a single-center retrospective cohort study of children and adolescents (<18 years of age) who underwent HSCT over a 20-year period (1997-2016). We determined the incidence and case fatality rate of HA-BSI by causative organism. We used multivariable Poisson regression to identify risk factors for HA-BSI. Results:Of 1294 patients, the majority (86%) received an allogeneic HSCT, most commonly with umbilical cord blood (63%). During the initial HSCT hospitalization, 334 HA-BSIs occurred among 261 (20%) patients. These were classified as gram-positive bacterial (46%), gram-negative bacterial (24%), fungal (12%), mycobacterial (<1%), or polymicrobial (19%). During the study period, there was a decline in the cumulative incidence of HA-BSI (P = .021) and, specifically, fungal HA-BSIs (P = .002). In multivariable analyses, older age (incidence rate ratio [IRR], 1.03; 95% confidence interval [CI], 1.01-1.06), umbilical cord blood donor source (vs bone marrow; IRR, 1.69; 95% CI, 1.19-2.40), and nonmyeloablative conditioning (vs myeloablative; IRR, 1.85; 95% CI, 1.21-2.82) were associated with a higher risk of HA-BSIs. The case fatality rate was higher for fungal HA-BSI than other HA-BSI categories (21% vs 6%; P = .002). Conclusions:Over the past 2 decades, the incidence of HA-BSIs has declined among pediatric HSCT recipients at our institution. Older age, umbilical cord blood donor source, and nonmyeloablative conditioning regimens are independent risk factors for HA-BSI among children undergoing HSCT.
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Akinboyo, Ibukunoluwa C, Rebecca R Young, Lisa P Spees, Sarah M Heston, Michael J Smith, Yeh-Chung Chang, Lauren E McGill, Paul L Martin, et al. (2020). Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients. Open forum infectious diseases, 7(4). p. ofaa093. 10.1093/ofid/ofaa093 Retrieved from https://hdl.handle.net/10161/21201.
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Scholars@Duke
Ibukun Christine Kalu
My research focus is on developing methods to prevent infections and improve treatment outcomes in children.
Sarah Mabrey Heston
I am a Pediatric Transplant Infectious Diseases physician-scientist. Clinically, I diagnose and treat infections in immunocompromised children who have either undergone transplantation or who are receiving chemotherapy. My research interests are in utilizing the microbiome to improve clinical outcomes following transplantation. Specifically, I am evaluating the gut microbiomes of children undergoing hematopoietic cell transplantation (HCT) to identify actionable interventions to reduce mucosal barrier injury bloodstream infections and graft-versus-host disease, two significant contributors to post-HCT morbidity.
Yeh-Chung Chang
My interests include infections in immunocompromised hosts and I help run the Pediatric Transplant ID clinical service. At Duke, these populations include pediatric solid organ transplant recipients, bone marrow transplant recipients, and Oncology patients. My personal research includes EBV infection and post-transplant lymphoprolifeartive disease (PTLD), as well as vaccine responses in the immunocompromised host populations. I am also involved in studies evaluating invasive fungal infections and pharmacokinetics of antifungal medications.
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