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Mucosal barrier injury-associated bloodstream infections in pediatric oncology patients
Hana Hakim1, Amy L Billett2, Jiahui Xu3
1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Mucosal barrier injury bloodstream infections (MBI-LCBI) are a significant concern in pediatric hematology oncology transplant (PHO) patients. This study highlights the substantial burden of MBI-LCBI across both inpatient and ambulatory settings, informing prevention strategies.
Area of Science:
- Infectious Diseases
- Pediatric Hematology Oncology
- Healthcare Epidemiology
Background:
- Central line-associated bloodstream infections (CLABSI) and mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBI) are critical in pediatric hematology oncology transplant (PHO) patients.
- Previous research primarily focused on inpatient MBI-LCBI, necessitating broader characterization across care settings.
Purpose of the Study:
- To characterize MBI-LCBI in pediatric hematology oncology transplant (PHO) patients across both inpatient and ambulatory settings.
- To provide data for improved surveillance and prevention strategies for MBI-LCBI in PHO patients.
Main Methods:
- Analysis of prospectively collected data on CLABSI and MBI-LCBI from a US PHO multicenter quality improvement network (August 2013-December 2015).
- Application of CDC National Healthcare Safety Network definitions, adapted for ambulatory events.
Main Results:
- 35 PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events.
- Ambulatory MBI-LCBI rate was 0.085/1000 line days; inpatient rate was 1.01/1000 line days.
- Neutropenia was present in ≥90% of MBI-LCBI events; common pathogens included Escherichia coli, Klebsiella spp., and viridans streptococci.
Conclusions:
- The burden of MBI-LCBI is substantial across the continuum of care for PHO patients.
- Findings underscore the need for increased awareness among healthcare providers regarding MBI-LCBI in PHO patients.
- Data can aid in benchmarking and informing prevention and treatment strategies for MBI-LCBI.
Background:
Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies.
Methods:
Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events.
Results:
Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P < 0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting.
Conclusion:
In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.
