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Updated: Nov 29, 2025
Author Spotlight: Exploring the Lifespan Dynamics of Healthy Human Hematopoiesis
Published on: December 8, 2023
Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center
Sarah M Heston1, Rebecca R Young1, Hwanhee Hong2
1Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
Insights
Bloodstream infections (BSIs) remain a significant threat in pediatric hematopoietic stem cell transplant (HSCT) recipients, with high incidence rates observed over two decades. New prevention strategies are crucial for this vulnerable population.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Transplantation Medicine
Background:
- Bloodstream infections (BSIs) are a common complication following hematopoietic stem cell transplantation (HSCT).
- Understanding the evolving microbiology of BSIs is critical for effective treatment and prevention in pediatric HSCT recipients.
Purpose of the Study:
- To analyze the microbiological trends of BSIs in pediatric HSCT patients over a 20-year period.
- To inform antimicrobial prescribing and infection control strategies based on historical BSI data.
Main Methods:
- Retrospective cohort study of pediatric HSCT recipients (1997-2015).
- Utilized recurrent-event gap-time Cox proportional hazards models to assess BSI risks.
- Compared time to BSI by organism type and analyzed antibiotic resistance trends.
Main Results:
- A total of 865 BSIs were recorded, with Gram-positive bacteria being the most common (48%).
- The overall hazard of BSIs did not change significantly, but fungal BSIs decreased (P=.04).
- Vancomycin resistance in Enterococcus faecium increased (P=.0007), and BSIs were associated with increased mortality risk.
Conclusions:
- Despite prevention efforts, BSIs remain a high-incidence issue in pediatric HSCT patients.
- Fungal BSIs declined, while mycobacterial BSIs occurred later post-HSCT.
- Urgent development of novel prevention strategies is necessary for this high-risk group.
Background:
Bloodstream infections (BSIs) occur frequently after hematopoietic stem cell transplantation (HSCT). We examined the microbiology of BSI in pediatric HSCT recipients over a 2-decade period at our institution to inform empirical antimicrobial prescribing and infection prevention strategies.
Methods:
We conducted a retrospective cohort study of children (<18 years) who underwent HSCT at Duke University between 1997 and 2015. We used recurrent-event gap-time Cox proportional hazards models to determine the hazards of all-cause and cause-specific BSI according to HSCT year. We compared the median time to BSI by causative organism type and evaluated for temporal trends in the prevalence of antibiotic resistance among causative organisms.
Results:
A total of 865 BSI occurred in 1311 children, including 412 (48%) Gram-positive bacterial, 196 (23%) Gram-negative bacterial, 56 (6%) fungal, 23 (3%) mycobacterial, and 178 (21%) polymicrobial BSI. The hazard of all BSIs did not change substantially over time during the study period, but the hazard of fungal BSIs declined over time during the study period (P = .04). Most fungal BSIs (82%) occurred in the first 100 days after HSCT, whereas mycobacterial BSIs occurred later after HSCT than BSIs caused by other organisms (P < .0001). The prevalence of vancomycin resistance among BSIs caused by Enterococcus faecium increased during the study period (P = .0007). The risk of 2-year mortality in children was increased with BSI (P = .02), Gram-negative bacterial BSI (P = .02), and fungal BSI (P < .0001).
Conclusions:
Despite expanded practices for BSI prevention over the past several decades, the incidence of BSI remains high in pediatric HSCT recipients at our institution. Additional strategies are urgently needed to effectively prevent BSIs in this high-risk population.
