Impact of hospital acquired infections on post-transplant one year mortality in pediatric bone marrow transplant patients

Benjamin R Hanisch; William Cohen; David Jacobsohn; Xiaoyan Song

doi:10.1016/j.ajic.2020.07.020

Impact of hospital acquired infections on post-transplant one year mortality in pediatric bone marrow transplant patients

Am J Infect Control. 2021 Feb;49(2):179-183. doi: 10.1016/j.ajic.2020.07.020. Epub 2020 Jul 16.

Authors

Benjamin R Hanisch¹, William Cohen², David Jacobsohn³, Xiaoyan Song⁴

Affiliations

¹ Department of Pediatrics, George Washington University, Washington, DC; Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC. Electronic address: BHanisch@childrensnational.org.
² University of Chicago, Chicago, IL.
³ Department of Pediatrics, George Washington University, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC.
⁴ Department of Pediatrics, George Washington University, Washington, DC; Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC.

PMID: 32682014
DOI: 10.1016/j.ajic.2020.07.020

Abstract

Objective: Children undergoing hematopoietic stem cell transplant (HSCT) are prone to infections, especially when hospitalized for the transplant or additional medical care. These infections are perceived to increase patient's mortality risk, but data are lacking. We conducted this study to assess the burden and the impact of hospital acquired infections (HAI) on mortality risk among pediatric HSCT patients.

Methods: This retrospective study included 169 patients that received allogeneic HSCT between January 1 2011 and July 6 2017 at Children's National Hospital, a tertiary referral center. Clinical and laboratory data were reviewed for 1 year after transplant to determine HAI and survival status. The HAI incident rates stratified by bloodstream, respiratory, and gastrointestinal infections were then compared between deceased patients and survivors.

Results: Including transplant, 169 patients sustained 499 hospital admissions for total of 10,523 patient days and 112 HAI episodes, resulting in a HAI rate of 10.6 per 1,000 patient-days. Within 1-year after transplant, 38 (22%) patient died, 30 (17.5%) with nonrelapse-related causes. Unadjusted univariate analysis revealed mortality correlated with cell source (p=0.035), donor type (p = 0.002), respiratory viral infections (P = .015), and central line associated blood stream infection (CLABSIs; P < .001). Adjusted analysis revealed CLABSI and respiratory adenovirus infection independently increased mortality risk by 3-fold (hazard ratio: 3.22, 95% confidence interval:1.30-8.00) and (hazard ratio: 3.32, 95% confidence interval: 1.22-9.06), respectively.

Conclusions: In light of the high frequency of multiple factors contributing to mortality we are unable to determine the degree HAI contributed mortality. However, our findings suggest preventing CLABSIs and respiratory adenovirus infections are crucial to improve the 1-year survival among pediatric HSCT patients.

Keywords: Central line associated blood stream infections; HSCT.

MeSH terms

Bone Marrow Transplantation
Child
Cross Infection* / epidemiology
Hematopoietic Stem Cell Transplantation* / adverse effects
Hospitals
Humans
Retrospective Studies