Akinboyo Ibukunoluwa C, Young Rebecca R, Spees Lisa P, Heston Sarah M, Smith Michael J, Chang Yeh-Chung, McGill Lauren E, Martin Paul L, Jenkins Kirsten, Lugo Debra J, Hazen Kevin C, Seed Patrick C, Kelly Matthew S
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
Open Forum Infect Dis. 2020 Mar 16;7(4):ofaa093. doi: 10.1093/ofid/ofaa093. eCollection 2020 Apr.
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.
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.
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 ( = .021) and, specifically, fungal HA-BSIs ( = .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%; = .002).
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.
接受造血干细胞移植（HSCT）的儿童发生医院相关血流感染（HA-BSIs）的风险很高。本研究旨在描述儿科HSCT受者中HA-BSI的发生率、微生物学特征及危险因素。
我们对1997年至2016年20年间接受HSCT的儿童和青少年（<18岁）进行了一项单中心回顾性队列研究。我们根据致病微生物确定了HA-BSI的发生率和病死率。我们使用多变量泊松回归来确定HA-BSI的危险因素。
在1294例患者中，大多数（86%）接受了异基因HSCT，最常见的是脐带血移植（63%）。在初次HSCT住院期间，261例（20%）患者发生了334例HA-BSI。这些感染分为革兰氏阳性菌感染（46%）、革兰氏阴性菌感染（24%）、真菌感染（12%）、分枝杆菌感染（<1%）或混合感染（19%）。在研究期间，HA-BSI的累积发生率有所下降（P = 0.021），特别是真菌性HA-BSI（P = 0.002）。在多变量分析中，年龄较大（发病率比[IRR]，1.03；95%置信区间[CI]，1.01 - 1.06）、脐带血供体来源（与骨髓相比；IRR，1.69；95%CI，1.19 - 2.40）和非清髓性预处理（与清髓性预处理相比；IRR，1.85；95%CI，1.21 - 2.82）与HA-BSI的较高风险相关。真菌性HA-BSI的病死率高于其他HA-BSI类别（21%对6%；P = 0.002）。
在过去20年中，我们机构儿科HSCT受者中HA-BSI的发生率有所下降。年龄较大、脐带血供体来源和非清髓性预处理方案是接受HSCT儿童发生HA-BSI的独立危险因素。
