200 Trends in Bloodstream Bacterial Infections and Resistance Patterns over the Past Decade in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Alicia K Chang, MD , Pediatrics, Columbia University, New York, NY
Marc Foca , Pediatrics, Columbia University, New York, NY
Zhezhen Jin, PhD , Biostatistics, Columbia University, New York, NY
Virginia Laird , Pediatrics, Columbia University, New York, NY
Sharon Shwartz , Pediatrics, Columbia, New York, NY
Anya Levinson , Pediatrics, Columbia University, New York, NY
Monica Bhatia, MD , Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University, New York, NY
Esra Karamehmet , Columbia University Medical Center, New York, NY
James Garvin, MD, PhD , Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University, New York, NY
Diane George, MD , Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University, New York, NY
Prakash Satwani, MD , Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY
Presentation recording not available for download or distribution as requested by the presenting author.
Introduction

                  Bacterial bloodstream infections (BBSIs) contribute significantly to transplant related mortality (TRM) post allogeneic hematopoietic cell transplant (alloHCT). In 2006, a new central-line associated bloodstream infection (CLABSI) protocol was established at our institution. We report the incidence rate and sensitivities of both Gram negative rod (GNR) and Gram positive cocci (GPC) BBSIs during Pre-CLABSI era (2004-06), CLABSI era (2006-10), and post-CLABSI era (2010-13).

Methods

A retrospective chart review between 2004-2013 was conducted. 100 person-month bacterial infection incidences were calculated and compared by Poisson regression analysis. Patients did not receive prophylactic anti-bacterial antibiotics and piperacillin/tazobactam was started at the onset of fever.

Results

                  Between 2004-13, 302 BBSIs were identified in 190 patients (mean age 9.97 years).  Malignant 111 (58.4%), Non-malignant 79 (41.6%); donor source: Marrow 71 (37.4%), Peripheral Blood Stem Cell 59 (31.1%), Cord blood 60 (31.5%). Conditioning regimens: myeloablative= 86 (45.3%), reduced toxicity= 57 (30%), reduced intensity= 47 (24.7%); incidence of neutrophil engraftment by day +30 was 82%, and incidence of grade II-IV aGVHD was 44.2%, 

For the different time periods of immune reconstitution, the rate per 100 person months of bacterial infections decreased as shown in table 1. Of the BBSIs for each time period, the proportion of GPC BBSIs decreased (2004-06:56%, 2006-10:53.1%, 2010-13:39.2%, respectively), 2004-06 vs. 2010-13, p=0.048.

GNR antibiotic resistance increased to levofloxacin (4.4% from 2004-06 to 17.2% from 2010-2013), decreased to cefepime (13.3% from 2004-06 to 7.7% from 2010-13), and remained stable to piperacillin-tazobactam (7.7% in 2004-06 to 9.1% from 2010-13). GPC antibiotic resistance to vancomycin increased from 3.4% in 2004-06 to 10.5% in 2010-13.

Lastly, in our multivariate analysis RTC regimen was a significant risk factor for the development of piperacillin-tazobactam resistance in GNR (OR 4.421, 95% CI 1.331-14.69, p=0.015). TRM was significantly higher in BBSI patient between 2004-06 (27.9%) vs.  2010-13 (9.3%) (p=0.03).

Discussion

            Our analysis showed a decrease in BBSI rates after CLABSI protocol was implemented at our institution and a significant decline in BBSI in the post-CLABSI era. The proportion of GPC infections decreased over this time period. However, further investigation on factors associated with decrease in BBSI in these different time periods is ongoing. The rise in vancomycin resistance (likely due to its widespread use as empiric antibiotic choice for alloHCT patients with fever), warrants further investigation.

 

 

2004-06

2006-10

2010-13

p

(2004-06 vs 2010-13)

Day 0 to +30

42.1%

33.4%

13.8%

0.016

Day +31 to +100

61.9%

30.5%

12.7%

<0.001

Day +101 to  +180

62.4%

45.7%

19.8%

0.001

Day +181 to +365

26.3%

19.9%

5.0%

<0.001

Disclosures:
Nothing To Disclose