Paper: Incidence and Outcome of Pediatric Hematopoietic Transplant Patients Diagnosed with the New Classification Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI)

Poster Abstracts

Grand Hall CD (Manchester Grand Hyatt)

Christopher E Dandoy, MD, MSc , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Stella M. Davies, MBBS, PhD, MRCP , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Evaline Alessandrini , Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Jack Bleesing, MD, PhD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Sharat Chandra, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Lara Danziger-Isakov, MD , Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Kathleen Marie Demmel, BSN, RN, MHA , Cancer and Blood Diseases Institute, Cincinnati Children's Hospital, Cincinnati, OH

Javier El-Bietar, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Alexandra Filipovich, MD , Division of Bone Marrow Transplantation & Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Laura Flesch, MSN, RN, CRNP , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Michael S. Grimley, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Sonata Jodele, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Michael B Jordan, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pooja Khandelwal, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Ashish Kumar, MD, PhD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Adam Lane, PhD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Rebecca A. Marsh, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Parinda A. Mehta, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Kasiani C. Myers, MD , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Rajaram Nagarajan , Cincinnati Children's Hospital Medical Center, cincinnati, OH

Adam Stuart Nelson, MD , Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Abigail Pate , Cincinnati Children's Hospital Medical Center, Bone Marrow Transplantation and Immune Deficiency, Cincinnati, OH

Gregory Wallace, DO , Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

David Haslam , cincinnati Children's Hospital Medical Center, cincinnati, OH

Beverly Connelly, MD , Pediatric Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Presentation recording not available for download or distribution as requested by the presenting author.

Background: In 2013, the Centers for Disease Control and Prevention developed a modification of blood stream infection (BSI) definition, termed mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI). In January of 2013, the National Healthcare Safety Network (NHSN) integrated a MBI-LCBI definition into the methods for BSI surveillance to aid in identification of BSIs reported as central line associated blood stream infections (CLABSI) likely related to mucosal barrier injury. There is little literature describing the timing, patients at risk, and incidence of MBI-LCBIs in comparison to CLABSIs and BSIs from a secondary source (secondary BSIs).

Methods: We reviewed all BSIs in SCT patients from May 2011 to April 2014 at our center to determine the timing, underlying diagnosis, and outcomes of patients diagnosed with MBI-LCBIs, CLABSIs and secondary BSIs after stem cell transplant (SCT).. We applied the new MBI-LCBI classification to patients undergoing SCT prior to NHSN criteria implementation.

Results: 299 patients underwent SCT during the 36-month study period. 34 CLABSIs, 30 MBI-LCBIs, and 26 secondary BSIs were diagnosed in 64 patients (21%). Thirteen patients (20%) had more than one infection accounting for 39 of the 90 (43%) infections. MBI-LCBIs occurred shortly after SCT at a median of 7 days after transplant. 11 of 14 patients with MBI-LCBIs after day +30 (including patients with > 1 infection) were diagnosed with GVHD, with 10/11 having GI-GVHD.

Conclusions: One third of BSIs were classified as an MBI-LCBI. MBI-LCBIs occurred earlier after SCT than CLABSIs and secondary BSIs, likely due to mucositis, and were associated with GVHD after day +30. As the MBI-LCBI classification is new, further research is needed to understand the pathogenesis and prevention of MBI-LCBIs.

Table: Demographics and outcomes of patients a BSI after SCT. 13 patients had >1 infection accounting for 39 total infections.

MBI-LCBI (n=18)

CLABSI
(n=20)

Secondary BSI
(n=13)

> 1 BSI after HSCT
(n=13 patients)

Mean age (years) at SCT (Range)

7.1 (0.9-28.7)

4.6 (0.3-29.8)

5.4 (0.9-32.8)

9.2 (2.2-27.5)

Median days from SCT to BSI (IQR)

7 (4-55)

59 (8-137)

70 (48-118)

149 (58-313)

Diagnosis
Immune Deficiency (n=32)
Malignancy (n=17)
Marrow Failure (n=8)
Benign Hematology (n=5)
Genetic/Metabolic (n=2)

8 (44%)

13 (65%)

4 (31%)

7 (54%)

6 (33%)

5 (25%)

3 (23%)

3 (23%)

2 (11%)

0

3 (23%)

3 (23%)

1 (6%)

1 (5%)

3 (23%)

0

1(6%)

1 (5%)

0

0

Myeloablative conditioning (n=28)

8 (44%)

12 (60%)

5 (38%)

3 (23%)

GVHD (Grade II-IV) at 100 days (n=19)

4 (22%)

5 (25%)

6 (46%)

4 (31%)

Sepsis/shock (n=31)

4 (22%)

10 (50%)

3 (23%)

14 (36%)

ICU care within 7 days of BSI (n=15)

4 (22%)

4 (20%)

3 (23%)

4 (10%)

Died (n=27)

8 (44%)

8 (40%)

3 (23%)

8 (62%)

Non relapsed mortality (n=20)

6 (33%)

6 (30%)

3 (23%)

5 (38%)

Median days from BSI to death (IQR)

90 (51-152)

119 (50-206)

44 (34-63)

In patients with > 1 BSI, median days from last BSI to death (IQR)

156 (113-302)

Disclosures:

Nothing To Disclose

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289 Incidence and Outcome of Pediatric Hematopoietic Transplant Patients Diagnosed with the New Classification Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections (MBI-LCBI)