Bacterial bloodstream infections in pediatric allogeneic hematopoietic stem cell recipients before and after implementation of a central line-associated bloodstream infection protocol: A single-center experience

Chang, Andrew; Foca, Marc; Jin, Zhezhen; Vasudev, Rahul; Laird, Mary E.; Schwartz, Stanley; Qureshi, Mahvish; Kolb, Michelle; Levinson, Anya; Bhatia, Monica; Kung, Andrew L.; Garvin, James H.; George, Diane; Della‐Latta, Phyllis; Whittier, Susan; Saiman, Lisa; Satwani, Prakash

doi:10.1016/j.ajic.2016.04.229

Cited by 24 publications

(15 citation statements)

References 29 publications

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“…Standardization of bundle elements coupled with systematic implementation and compliance has been shown to effectively and significantly reduce CLABSI rates across multiple studies involving pediatric oncology and HCT patients in the inpatient setting. [86][87][88][89][90] Best practice bundle implementation with particular focus on maintenance strategies also reduces CLABSI rates in the ambulatory setting. 86,91 As part of a multicenter quality improvement initiative, 32 pediatric hematology/oncology and HCT centers across the United States implemented a standardized CVC care bundle.…”

Section: Bloodstream Infection Preventionmentioning

confidence: 99%

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

Dandoy

Ardura

Papanicolaou

et al. 2017

Bone Marrow Transplant

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Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.

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Section: Bloodstream Infection Preventionmentioning

confidence: 99%

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

Dandoy

Ardura

Papanicolaou

et al. 2017

Bone Marrow Transplant

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“…Many centers use vancomycin for empiric coverage for fever in persistently febrile patients because of concerns of bacteremia from oral flora during mucositis. In a recent study, we demonstrated that all streptococcal infections early after alloHCT (day 0 to day +30) are sensitive to penicillin [16]. The empiric use and duration of vancomycin for febrile patients with mucositis should be further investigated.…”

Section: Discussionmentioning

confidence: 96%

“…In the field of pediatric alloHCT, various studies have described risk factors associated with bacteremia [6,7,[15][16][17]. However, there is minimal literature describing antibiotic resistance in pediatric alloHCT.…”

Section: Discussionmentioning

confidence: 99%

“…Primary prevention of a first episode of bacteremia is arguably the most important intervention to decrease antibiotic resistance. An emphasis should be placed on preventing BSI; for example, we recently demonstrated that implementation of a central line bundle significantly decreased the incidence of gram-positive and gram-negative infections [16]. Recently launched prospective studies aimed at decreasing the incidence of bacteremia, using strategies such as prophylactic levofloxacin (ClinicalTrials.gov Identifier: NCT01371656), chlorhexidine baths (ClinicalTrials.gov Identifier: NCT01817075), or probiotics (COG study-ACCL 1633) to stabilize gastrointestinal microbiome will hopefully decrease the incidence of bacteremia and, subsequently, antibiotic resistance in this population.…”

Section: Shono Et Al Recently Demonstrated That Treatment Ofmentioning

confidence: 99%

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A Multicenter Study of Bacterial Blood Stream Infections in Pediatric Allogeneic Hematopoietic Cell Transplantation Recipients: The Role of Acute Gastrointestinal Graft-versus-Host Disease

Satwani

Freedman

Chaudhury

et al. 2017

Biology of Blood and Marrow Transplantation

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Blood stream infections (BSI) caused by enteric organisms are associated with a particularly high mortality rate in allogeneic hematopoietic cell transplantation (alloHCT) recipients. We conducted a retrospective multicenter study aiming to analyze the risk factors associated with antibiotic resistance and impact of BSI on transplantation-related mortality (TRM) in children after alloHCT. During the study period from 2004 to 2014, 395 children (mean age, 9.4 years) with at least 1 BSI were included. The incidences of resistant gram-negative rods were 20.7% to piperacillin-tazobactam, 10.9% to cefepime, 21% to ceftazidime, 11.4% to levofloxacin, and 8.16% to meropenem. Thirty-eight percent of Enterococcus spp. isolates were resistant to vancomycin. More than 1 episode of BSI was associated with significant increase in the risk of resistance to piperacillin-tazobactam, cefepime, and vancomycin. On multivariate analysis of risk factors for TRM, achievement of neutrophil engraftment by day 30 was associated with lower TRM (P = .002). However, infection with an antibiotic-resistant organism was not associated with TRM. Development of enteric bacterial BSI after the onset of acute gastrointestinal graft-versus-host disease (GVHD) was the strongest predictor of TRM (hazard ratio, 4.786; 95% confidence interval, 2.833 to 8.087; P < .001). In patients with acute gastrointestinal GVHD who subsequently developed enteric bacterial BSI, the incidence of 1-year TRM was 33.4% (SE = 7%), compared with 15.3% (SE = 2%) for those without acute gastrointestinal GVHD (P = .004). Primary prevention of a first episode of BSI is arguably the most important intervention to decrease antibiotic resistance. It is also imperative that we develop strategies to maintain gastrointestinal health, especially in patients with gastrointestinal GVHD, in an effort to prevent subsequent enteric bacterial BSI and improve survival.

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“…7,8 Other associated factors can influence the development of infectious complications in these patients, such as central venous catheters (CVCs), presence of comorbidities, intensity and duration of neutropenia, mucositis, and use of antimicrobial prophylaxis. 9,10 It has long been known that CVC-associated infections in cancer patients are related to a sevenfold increase in mortality rates in this population. 11 Although HSCT has been performed since the late 1970s in Brazil, few studies have thus far addressed its distinctive infectious features and complications in children and adolescents in our country.…”

Section: Introductionmentioning

confidence: 99%

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients

Teixeira

Diniz

Mourão

et al. 2017

European J of Haematology

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Objective: To describe the profile of reported healthcare-associated infections (HAIs) in pediatric patients submitted to hematopoietic stem cell transplantation (HSCT) at a reference center.Methods: Retrospective cohort of pediatric patients who were submitted to HSCT from 2008 to 2016. The criteria for HAI were based on those established by the National Healthcare Safety Network. Data were collected by active surveillance performed daily by professionals. This study was approved by the institutional research ethics committee.Results: A total of 86 HSCTs were performed in 81 patients younger than 18 years of age (median, 10 years). Of these, 69 (85%) were males. Aplastic anemia and leukemia were the main diagnoses. A total of 140 HAIs were diagnosed with an incidence density of 28.2 infections/1000 patient-days. The most common HAI was laboratoryconfirmed bloodstream infection (46), the majority of which was reported to be central venous catheter-associated (43). Gram-negative bacteria were the most prevalent microorganisms (58.5%). Almost all the infections occurred until 30 days after transplantation, and 17 deaths were observed within 180 days after the procedure. Conclusion:Active surveillance of HAIs in HSCT children allowed the evaluation of the incidence and profile of HAIs, which is essential for the health care of these patients. K E Y W O R D Sbone marrow transplantation, immunology and infectious diseases, pediatric hematology | INTRODUCTIONHematopoietic stem cell transplantation (HSCT) is considered a therapeutic option for several neoplastic and non-neoplastic diseases.However, complications are still frequent, with a high impact on morbidity and hospital economic outcomes. Several factors associated with both the underlying disease and HSCT affect the profile of infections in transplant recipients, such as

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Bacterial bloodstream infections in pediatric allogeneic hematopoietic stem cell recipients before and after implementation of a central line-associated bloodstream infection protocol: A single-center experience

Cited by 24 publications

References 29 publications

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

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

A Multicenter Study of Bacterial Blood Stream Infections in Pediatric Allogeneic Hematopoietic Cell Transplantation Recipients: The Role of Acute Gastrointestinal Graft-versus-Host Disease

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients

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