Microbiology and risk factors for hospital-associated bloodstream infections among pediatric hematopoietic stem cell transplant recipients

Ibukunoluwa C. Akinboyo*, Rebecca R. Young, Lisa P. Spees, Sarah M. Heston, Michael J. Smith, Yeh Chung Chang, Lauren E. McGill, Paul L. Martin, Kirsten Jenkins, Debra J. Lugo, Kevin C. Hazen, Patrick C. Seed, Matthew S. Kelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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.

Original languageEnglish (US)
Article numberofaa093
JournalOpen Forum Infectious Diseases
Issue number4
StatePublished - 2020


  • Antifungal prophylaxis
  • Conditioning regimen
  • Mortality
  • Umbilical cord blood

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology


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