[Analysis of Risk Factors for Bloodstream Infections in Children with Aplastic Anemia after Allogeneic Hematopoietic...

To investigate the clinical characteristics, pathogenic distribution, and risk factors of bloodstream infection (BSI) in children with aplastic anemia (AA) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), to provide clinical evidence for the early identification of high-risk patients and optimization of empirical antibacterial therapy regimens.

The clinical data of 113 children with AA who underwent allo-HSCT at the Pediatric Hematology and Oncology Center of Wuhan Children's Hospital from August 2016 to December 2024 were retrospective collected. The incidence of bloodstream infection, pathogenic distribution, and identify relevant risk factors in these patients was analyzed.

Among the 113 children with AA, 23 cases (20.4%) developed bloodstream infection after allo-HSCT. A total of 26 pathogenic strains were isolated, including 13 Gram-negative strains (50.0%), 10 Gram-positive strains (38.5%), and 3 fungal strains (11.5%). The most commonly detected pathogenic bacteria were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, with the detection rate of carbapenem-resistant Gram-negative organisms (CRO) reaching 26.1%. Multivariate analysis indicated that active infection prior to transplantation (HR=3.749, 95%CI:1.398-10.055, P=0.009) was an independent risk factor for post-transplant BSI. Moreover, the OS rate of children with agranulocytosis duration >17 days was significantly lower than that of those with agranulocytosis duration ≤17 days.

Gram-negative bacteria are the predominant pathogens causing bloodstream infection in children with AA following allo-HSCT. Additionally, the presence of active infection prior to transplantation was identified as an independent risk factor for post-transplant BSI.