Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients.

Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients.

Hakim H; Billett AL; Xu J; Tang L; Richardson T; Winkle C; Werner EJ; Hord JD; Bundy DG; Gaur AH

Pediatric Blood & Cancer

2020

2020-08

BACKGROUND: Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS: Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS: Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P  <  0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION: In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.

Humans; Male; Female; Child; Child Preschool; Bacterial Infections/epidemiology/therapy; bloodstream infections; CLABSI; Databases Factual; hematology; mucosal barrier injury; Neoplasms/epidemiology/therapy; Neutropenia/epidemiology/therapy; oncology; pediatric; transplant; Mucous Membrane/injuries

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journalArticle

e28234

8

67

1545-5017 1545-5009

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