Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

Christopher E. Dandoy, Tammy Kelley, Aditya H. Gaur, Rajaram Nagarajan, Kathy Demmel, Priscila Badia Alonso, Terri Guinipero, Stephanie Savelli, Hana Hakim, Angie Owings, Kasiani Myers, Victor Aquino, Carol Oldridge, Mary Lynn Rae, Katharine Schjodt, Tracie Kilcrease, Michelle Scurlock, Ann M. Marshburn, Margaret Hill, Mary LangevinJennifer Lee, Raven Cooksey, Amir Mian, Shelby Eckles, Justin Ferrell, Javier El-Bietar, Adam Nelson, Brian Turpin, Frederick S. Huang, John Lawlor, Megan Esporas, Adam Lane, Jeffrey Hord, Amy L. Billett

Research output: Contribution to journalArticle

Abstract

Background: Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods: This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results: Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions: BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

Original languageEnglish (US)
Article numbere27978
JournalPediatric Blood and Cancer
Volume66
Issue number12
DOIs
StatePublished - Dec 1 2019

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Hematology
Stem Cells
Pediatrics
Transplants
Infection
Hematopoietic Stem Cell Transplantation
Intensive Care Units
Quality Improvement
Mortality
Outcome Assessment (Health Care)

Keywords

  • BMT
  • ICU
  • immunocompromised hosts
  • Infections
  • infections in immunocompromised hosts
  • outcomes research
  • pediatric hematology/oncology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Dandoy, C. E., Kelley, T., Gaur, A. H., Nagarajan, R., Demmel, K., Alonso, P. B., ... Billett, A. L. (2019). Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. Pediatric Blood and Cancer, 66(12), [e27978]. https://doi.org/10.1002/pbc.27978

Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. / Dandoy, Christopher E.; Kelley, Tammy; Gaur, Aditya H.; Nagarajan, Rajaram; Demmel, Kathy; Alonso, Priscila Badia; Guinipero, Terri; Savelli, Stephanie; Hakim, Hana; Owings, Angie; Myers, Kasiani; Aquino, Victor; Oldridge, Carol; Rae, Mary Lynn; Schjodt, Katharine; Kilcrease, Tracie; Scurlock, Michelle; Marshburn, Ann M.; Hill, Margaret; Langevin, Mary; Lee, Jennifer; Cooksey, Raven; Mian, Amir; Eckles, Shelby; Ferrell, Justin; El-Bietar, Javier; Nelson, Adam; Turpin, Brian; Huang, Frederick S.; Lawlor, John; Esporas, Megan; Lane, Adam; Hord, Jeffrey; Billett, Amy L.

In: Pediatric Blood and Cancer, Vol. 66, No. 12, e27978, 01.12.2019.

Research output: Contribution to journalArticle

Dandoy, CE, Kelley, T, Gaur, AH, Nagarajan, R, Demmel, K, Alonso, PB, Guinipero, T, Savelli, S, Hakim, H, Owings, A, Myers, K, Aquino, V, Oldridge, C, Rae, ML, Schjodt, K, Kilcrease, T, Scurlock, M, Marshburn, AM, Hill, M, Langevin, M, Lee, J, Cooksey, R, Mian, A, Eckles, S, Ferrell, J, El-Bietar, J, Nelson, A, Turpin, B, Huang, FS, Lawlor, J, Esporas, M, Lane, A, Hord, J & Billett, AL 2019, 'Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients', Pediatric Blood and Cancer, vol. 66, no. 12, e27978. https://doi.org/10.1002/pbc.27978
Dandoy, Christopher E. ; Kelley, Tammy ; Gaur, Aditya H. ; Nagarajan, Rajaram ; Demmel, Kathy ; Alonso, Priscila Badia ; Guinipero, Terri ; Savelli, Stephanie ; Hakim, Hana ; Owings, Angie ; Myers, Kasiani ; Aquino, Victor ; Oldridge, Carol ; Rae, Mary Lynn ; Schjodt, Katharine ; Kilcrease, Tracie ; Scurlock, Michelle ; Marshburn, Ann M. ; Hill, Margaret ; Langevin, Mary ; Lee, Jennifer ; Cooksey, Raven ; Mian, Amir ; Eckles, Shelby ; Ferrell, Justin ; El-Bietar, Javier ; Nelson, Adam ; Turpin, Brian ; Huang, Frederick S. ; Lawlor, John ; Esporas, Megan ; Lane, Adam ; Hord, Jeffrey ; Billett, Amy L. / Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients. In: Pediatric Blood and Cancer. 2019 ; Vol. 66, No. 12.
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abstract = "Background: Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods: This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results: Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37{\%}) were associated with at least one adverse outcome. All-cause mortality was 1{\%} (n = 9), 3{\%} (n = 26), and 6{\%} (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17{\%}) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions: BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.",
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T1 - Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

AU - Dandoy, Christopher E.

AU - Kelley, Tammy

AU - Gaur, Aditya H.

AU - Nagarajan, Rajaram

AU - Demmel, Kathy

AU - Alonso, Priscila Badia

AU - Guinipero, Terri

AU - Savelli, Stephanie

AU - Hakim, Hana

AU - Owings, Angie

AU - Myers, Kasiani

AU - Aquino, Victor

AU - Oldridge, Carol

AU - Rae, Mary Lynn

AU - Schjodt, Katharine

AU - Kilcrease, Tracie

AU - Scurlock, Michelle

AU - Marshburn, Ann M.

AU - Hill, Margaret

AU - Langevin, Mary

AU - Lee, Jennifer

AU - Cooksey, Raven

AU - Mian, Amir

AU - Eckles, Shelby

AU - Ferrell, Justin

AU - El-Bietar, Javier

AU - Nelson, Adam

AU - Turpin, Brian

AU - Huang, Frederick S.

AU - Lawlor, John

AU - Esporas, Megan

AU - Lane, Adam

AU - Hord, Jeffrey

AU - Billett, Amy L.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background: Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods: This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results: Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions: BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

AB - Background: Pediatric hematology/oncology (PHO) patients receiving therapy or undergoing hematopoietic stem cell transplantation (HSCT) often require a central line and are at risk for bloodstream infections (BSI). There are limited data describing outcomes of BSI in PHO and HSCT patients. Methods: This is a multicenter (n = 17) retrospective analysis of outcomes of patients who developed a BSI. Centers involved participated in a quality improvement collaborative referred to as the Childhood Cancer and Blood Disorder Network within the Children's Hospital Association. The main outcome measures were all-cause mortality at 3, 10, and 30 days after positive culture date; transfer to the intensive care unit (ICU) within 48 hours of positive culture; and central line removal within seven days of the positive blood culture. Results: Nine hundred fifty-seven BSI were included in the analysis. Three hundred fifty-four BSI (37%) were associated with at least one adverse outcome. All-cause mortality was 1% (n = 9), 3% (n = 26), and 6% (n = 57) at 3, 10, and 30 days after BSI, respectively. In the 165 BSI (17%) associated with admission to the ICU, the median ICU stay was four days (IQR 2-10). Twenty-one percent of all infections (n = 203) were associated with central line removal within seven days of positive blood culture. Conclusions: BSI in PHO and HSCT patients are associated with adverse outcomes. These data will assist in defining the impact of BSI in this population and demonstrate the need for quality improvement and research efforts to decrease them.

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KW - ICU

KW - immunocompromised hosts

KW - Infections

KW - infections in immunocompromised hosts

KW - outcomes research

KW - pediatric hematology/oncology

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