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

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.

Section: Introductionmentioning

confidence: 99%

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

Dandoy

Kelley

Gaur

et al. 2019

Section: Introductionmentioning

confidence: 99%

“…Bacterial bloodstream infections (BSIs) are a common infectious complication following stem cell transplantation (SCT) in both pediatric and adult populations . The majority of BSI occurs during the preengraftment period and is associated with prolonged hospitalization, intensive care unit admission, and protracted antibiotic exposure, leading to increased morbidity and mortality . In particular, it has recently been shown that patients who have more than one BSI within the first year following SCT have a higher rate of nonrelapsed mortality (NRM) than patients experiencing a single BSI …”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have identified several risk factors associated with BSI. Specifically, neutropenia, mismatched unrelated donor status, myeloablative conditioning, the presence of high‐grade graft versus host disease (GVHD), and transplant‐associated thrombotic microangiopathy (TA‐TMA) have been implicated as predisposing factors to the development of BSI . To better understand the population of patients who develop recurrent BSI, we conducted a case series of SCT recipients who developed three or more BSIs during the first year after transplant.…”

Section: Introductionmentioning

confidence: 99%

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Multiple bloodstream infections in pediatric stem cell transplant recipients: A case series

Grossmann

Alonso

Nelson

et al. 2018

Bacterial bloodstream infections (BSIs) are associated with poor outcomes following stem cell transplantation (SCT). We describe the demographics, treatment, complications, and outcome of 23 pediatric SCT recipients who developed three or more BSIs in the first year after SCT at our center from 2011 through 2016. The majority underwent allogeneic SCT (n = 22/23;96%), mainly from an unrelated donor (n = 19/22,86%); developed grade 2-4 graft versus host disease (GVHD; n = 14/23, 61%), all steroid refractory; and were diagnosed with thrombotic microangiopathy (n = 21/23, 91%). One-year overall survival was 56% (n = 13/23). We observed a high rate of transplant-associated thrombotic microangiopathy and steroid-refractory acute GVHD in patients with three or more BSIs.

“…Sepsis and septic shock from bloodstream infections (BSI) are a growing health care burden in hospitalized pediatric oncology and hematopoietic stem cell transplant (HSCT) patients . BSI occur in nearly 30% of patients undergoing HSCT and are associated with prolonged hospitalization, septic shock, increased rates of intensive care admission, prolonged antibiotic treatment, and increased mortality . Fever is often the first symptom of sepsis, and initiation of broad‐spectrum antibiotics within 60 min of recognition of sepsis or septic shock has been shown to improve morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of continuous temperature monitoring in pediatric immunocompromised patients: A pilot study

Sampson

Hickey

Huber

et al. 2019

Early recognition of fever is paramount in reducing morbidity and mortality in immunocompromised patients. We performed a pilot study to determine the feasibility, safety, and tolerability of continuous temperature monitoring via TempTraq, a continuous temperature monitoring patch. Ten pediatric patients were enrolled and received continuous temperature monitoring over 5 days in addition to episodic monitor (standard of care). Episodic monitoring failed to detect fever in two patients and there was a significant delay (>12 h) of fever detection in two others that was detected with TempTraq. Additionally, caregivers reported TempTraq was tolerable and easy to apply.