Retrospective cohort study of the incidence, bacteriological profile and outcome of bacterial blood stream infections (BSI) in children after HSCT in a tertiary care hospital

摘要

Despite the rapid advances in the field of HSCT, infections particularly in the bloodstream, still by large remain one of the most important cause of morbidity and mortality in the peri-transplant period. Globally, the last 2 decades have seen a substantial shift in the epidemiological profile of bacterial BSI in patients undergoing HSCT. The aim of the study was to analyse the etiology, bacteriological profile and outcome of pediatric HSCT patients with suspected BSI during the initial 100 days post transplant, over a three year period (2013 -2016). Clinical and microbiological data was collected and retrospectively analysed. There were 52 documented episodes of BSI in a total of 161 patients at a median duration of 11 days after HSCT, out of which four episodes were double positive. The sensitivity pattern was 5 sensitive, 5-resistant, 30 MDR and 16 possible XDR strains of bacteria. Overall, Gram-negative bacteria (GNB) and Gram-positive bacteria (GPB) accounted for 71.4% and 28.6% episodes respectively. Over the three year period GNB gradually became the predominant group of bacteria among allogeneic HSCT recipients with the emergence of drug resistant strains, whereas in autologous recipients GPB was the predominant causative agent. Logistic regression analysis was performed on the data. On univariate analysis, Stem Cell Source (GCSF mobilized PBSC) (P=0.019) and Severe Acute GVHD (>Grade 2) (P=0.003) were statistically significant independent risk factors for bacterial BSI. On multivariable analysis Severe Acute GVHD (P=0.026) maintained strong association with bacterial BSI. At 100 days, Infection Related Mortality was 6.2% and Transplant Related Mortality was 14.3% in allogeneic transplant recipients. All the patients who underwent Autologous HSCT were alive at 100 days.