Catheter-related Bloodstream Infection in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.

Abstract

The aim of this study was to identify catheter-related bloodstream infection (CRBSI) episodes, to determine the causative agents and antibiotic susceptibility profiles, demographic characteristics, and clinical outcomes of patients treated in the pediatric bone marrow transplant (BMT) unit between November 2019 and July 2022. Forty patients were included in the study. The median patient age was 7.5 years (range: 1.5 to 19.9 y) and the most common underlying disease was ALL (77.5%). CRBSI was found to be significantly higher in haploidentic donors (P<0.001). When CRBSI was confirmed, 65% of the patients were neutropenic with a median duration of 17.5 days (range: 3 to 150). It was found that the mean time to CVC infection was 22 days (range: 5 to 118). As a result of multivariate logistic analysis (OR: 1.038 [95% CI: 1.007-1.070], P=0.018) of the time of infection of the catheter and mortality, it was determined that the mortality rate increased as the duration of the catheter remained. CRBSI was detected in 41.2% of transplanted patients and the overall mortality rate attributed to this complication was 10%. Among the patients, 22 (55%) were colonized before hematopoietic stem cell transplantation (HSCT), and gram-negative agents (n=15, 68%) mostly accounted for colonization. Gram-negative pathogens (60%) were found to be statistically significantly more common in CRBSI (P<0.01). The most common causative agent was K. pneumoniae (n=13, 32.5%). Of the gram-negative isolates (n=24), 17 (70.8%) were multidrug-resistant organisms (MDRO). A fluoroquinolone (80%) was used for antibiotic prophylaxis. Among patients with CRBSI, 65% had a fluoroquinolone-resistant isolate. We found a high rate of quinolone resistance among CRBSI isolates after the use of fluoroquinolone prophylaxis at our unit.