Bloodstream Infections in Children Undergoing Allogeneic, Autologous Hematopoietic Stem Cell Transplantation or Chimeric Antigen Receptor T Cell Therapy

Abstract

Topic Significance & Study Purpose/Background/Rationale Bloodstream infections (BSI) are a major source of morbidity in children receiving hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor (CAR) T cell therapy. An in-depth understanding of BSIs in this population is crucial to identify targets for prevention. The purpose of this study was to describe patient risk factors and characteristics of BSIs in children and adolescents undergoing HSCT and CAR T cell therapy. Methods, Intervention, & Analysis Patients were enrolled consecutively beginning on November 1, 2017. Male and female children, with any underlying diagnosis, ages 0 to 25 years were eligible and followed prospectively from the time of initiation of conditioning for autologous, allogeneic or CAR T cell therapy through October 1, 2018. Microbiology reports were tracked daily and positive blood culture results reviewed. Corresponding patient data was extracted from the electronic medical record in real time. Bloodstream infections were classified based on current Centers for Disease Control Guidelines. Descriptive, Chi-square and logistic regression analyses were done to elucidate risk factors and associations. Findings & Interpretation During the 11 month study period, 89 patients received 109 cell infusions. The mean age was 10.5 years with 38% Hispanic (n=34), 29% non-Hispanic (n=26) and 32% other (n=29) ethnicity. Mean length of stay (LOS) was 37.7 days. Thirty-two positive cultures were identified. Of the positive cultures, 19 gram-positive and 13 gram-negative organisms were isolated (Table 1). Figure 1 displays BSI classification by therapy type. The majority of BSIs were mucosal barrier injury-laboratory confirmed bloodstream infections, and occurred in patients receiving allogeneic HSCT. Hispanic ethnicity was associated with BSI incidence when compared to patients of non-Hispanic and unknown ethnicity (p Discussion & Implications Meticulous nursing assessment of oral and peri-rectal mucosa is necessary, along with evidence-based strategies to prevent central-line associated bloodstream infections. Future research is critical to develop and test MBI-LCBI prevention strategies and understand why patients of certain ethnic backgrounds may be at increased risk for BSI.