Central Line Associated Blood Stream Infection Incidence and Outcomes in a Large Autologous and Allogeneic Bone Marrow Transplant Cohort

Abstract

<h3>Background</h3> Patients undergoing bone marrow transplant (BMT) requiring central venous access are at high risk of central line associated blood stream infections (CLABSI) due to prolonged immunosuppression. Currently, there is limited literature directly comparing outcomes and incidences of CLABSIs in the autologous and allogeneic BMT populations. Here, we describe the incidence and outcome of CLABSIs in a large prospective cohort of allogeneic and autologous BMT patients at a quaternary adult oncology center. <h3>Methods</h3> A descriptive analysis was performed on a prospectively assembled cohort of BMT patients collected over a 30-month period between 2017 and 2019. CLABSI determination was made by infection control practitioners and physicians using standardized definitions. Outcomes, including 30-day hospitalization, ICU admission, and all-cause mortality were determined through chart reviews. Chi-square tests were used to assess statistical significance to compare simple proportions. <h3>Results</h3> Of 1278 patients in the cohort, 136 (11%) developed CLABSIs. A significantly higher proportion of allogeneic BMT patients developed CLABSI compared to the autologous BMT patients (21% and 5% of their respective populations, p<0.001). Of 136 patients, 43.4% required admission, 7.4% required ICU admission and 7.7% died within 30-days of the CLABSI onset. Although there were no significant differences between allogeneic and autologous cases in these outcomes, allogeneic cases had a significantly longer time to developing a CLABSI from transplant than autologous cases (median 53 days vs 10 days). <h3>Conclusions</h3> In this large prospective study of patients receiving bone marrow transplants, we found that allogeneic BMT patients are at higher risk for developing a CLABSI compared with autologous BMT patients. Furthermore, these infections are associated with a high degree of morbidity and mortality in both populations. Review of clinical and infection control protocols regarding central line access and maintenance are needed in order to reduce the incidence of this highly morbid complication.