{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:43:39Z","timestamp":1790844219346,"version":"4.1.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T00:00:00Z","timestamp":1584316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007890","name":"University of North Carolina at Chapel Hill","doi-asserted-by":"publisher","award":["T32-CA-116339"],"award-info":[{"award-number":["T32-CA-116339"]}],"id":[{"id":"10.13039\/100007890","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institutes of Health Career Development Award","award":["K23-AI135090"],"award-info":[{"award-number":["K23-AI135090"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-associated bloodstream infections (HA-BSIs). This study aimed to describe the incidence, microbiology, and risk factors for HA-BSI in pediatric HSCT recipients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a single-center retrospective cohort study of children and adolescents (&amp;lt;18 years of age) who underwent HSCT over a 20-year period (1997\u20132016). We determined the incidence and case fatality rate of HA-BSI by causative organism. We used multivariable Poisson regression to identify risk factors for HA-BSI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1294 patients, the majority (86%) received an allogeneic HSCT, most commonly with umbilical cord blood (63%). During the initial HSCT hospitalization, 334 HA-BSIs occurred among 261 (20%) patients. These were classified as gram-positive bacterial (46%), gram-negative bacterial (24%), fungal (12%), mycobacterial (&amp;lt;1%), or polymicrobial (19%). During the study period, there was a decline in the cumulative incidence of HA-BSI (P\u2005=\u2005.021) and, specifically, fungal HA-BSIs (P\u2005=\u2005.002). In multivariable analyses, older age (incidence rate ratio [IRR], 1.03; 95% confidence interval [CI], 1.01\u20131.06), umbilical cord blood donor source (vs bone marrow; IRR, 1.69; 95% CI, 1.19\u20132.40), and nonmyeloablative conditioning (vs myeloablative; IRR, 1.85; 95% CI, 1.21\u20132.82) were associated with a higher risk of HA-BSIs. The case fatality rate was higher for fungal HA-BSI than other HA-BSI categories (21% vs 6%; P\u2005=\u2005.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Over the past 2 decades, the incidence of HA-BSIs has declined among pediatric HSCT recipients at our institution. Older age, umbilical cord blood donor source, and nonmyeloablative conditioning regimens are independent risk factors for HA-BSI among children undergoing HSCT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaa093","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T03:47:34Z","timestamp":1584330454000},"source":"Crossref","is-referenced-by-count":13,"title":["Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0839-568X","authenticated-orcid":false,"given":"Ibukunoluwa C","family":"Akinboyo","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca R","family":"Young","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa P","family":"Spees","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA"},{"name":"Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M","family":"Heston","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Smith","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeh-Chung","family":"Chang","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E","family":"McGill","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"},{"name":"Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L","family":"Martin","sequence":"first","affiliation":[{"name":"Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Jenkins","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra J","family":"Lugo","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C","family":"Hazen","sequence":"first","affiliation":[{"name":"Pathology, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick C","family":"Seed","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S","family":"Kelly","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,16]]},"reference":[{"key":"2020040813153252000_CIT0001","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1016\/j.bbmt.2016.06.002","article-title":"Healthcare burden, risk factors, and outcomes of mucosal barrier injury laboratory-confirmed bloodstream infections after stem cell transplantation","volume":"22","author":"Dandoy","year":"2016","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0002","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1399-3062.2005.00088.x","article-title":"Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients","volume":"7","author":"Almyroudis","year":"2005","journal-title":"Transpl Infect Dis"},{"key":"2020040813153252000_CIT0003","article-title":"Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995\u20132014)","volume":"25(4):756\u201363","author":"Spees","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0004","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1056\/NEJMoa1004383","article-title":"Reduced mortality after allogeneic hematopoietic-cell transplantation","volume":"363","author":"Gooley","year":"2010","journal-title":"N Engl J Med"},{"key":"2020040813153252000_CIT0005","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s15010-011-0229-y","article-title":"Mortality after bloodstream infections in allogeneic haematopoietic stem cell transplant (HSCT) recipients","volume":"40","author":"Mikulska","year":"2012","journal-title":"Infection"},{"key":"2020040813153252000_CIT0006","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.bbmt.2015.06.017","article-title":"Impact of prophylactic levofloxacin on rates of bloodstream infection and fever in neutropenic patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation","volume":"21","author":"Satlin","year":"2015","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0007","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1017\/ice.2017.188","article-title":"Mucosal barrier injury central-line-associated bloodstream infections: what is the impact of standard prevention bundles?","volume":"38","author":"Vaughan","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020040813153252000_CIT0008","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.ajic.2016.04.229","article-title":"Bacterial bloodstream infections in pediatric allogeneic hematopoietic stem cell recipients before and after implementation of a central line-associated bloodstream infection protocol: a single-center experience","volume":"44","author":"Chang","year":"2016","journal-title":"Am J Infect Control"},{"key":"2020040813153252000_CIT0009","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1093\/cid\/ciy150","article-title":"Incidence, risk factors, and long-term outcome of acute leukemia patients with early candidemia after allogeneic stem cell transplantation: a study by the acute leukemia and infectious diseases working parties of European Society for Blood and Marrow Transplantation","volume":"67","author":"Cesaro","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2020040813153252000_CIT0010","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1038\/sj.bmt.1701562","article-title":"Bloodstream infections can develop late (after day 100) and\/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation","volume":"23","author":"Romano","year":"1999","journal-title":"Bone Marrow Transplant"},{"key":"2020040813153252000_CIT0011","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jbi.2010.11.008","article-title":"The DEDUCE guided query tool: providing simplified access to clinical data for research and quality improvement","volume":"44","author":"Horvath","year":"2011","journal-title":"J Biomed Inform"},{"key":"2020040813153252000_CIT0012","volume-title":"CDC\/NHSN Bloodstream Infection Event (Central Line- Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection)","author":"Centers for Disease Control and Prevention","year":"2018"},{"key":"2020040813153252000_CIT0013","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1086\/658334","article-title":"Impact of chlorhexidine bathing on hospital-acquired infections among general medical patients","volume":"32","author":"Kassakian","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020040813153252000_CIT0014","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1093\/cid\/ciy752","article-title":"Control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in healthcare facilities: a systematic review and reanalysis of quasi-experimental studies","volume":"68","author":"Tomczyk","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2020040813153252000_CIT0015","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1086\/588566","article-title":"Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms","volume":"29","author":"Goodman","year":"2008","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020040813153252000_CIT0016","doi-asserted-by":"crossref","first-page":"e0199616","DOI":"10.1371\/journal.pone.0199616","article-title":"Reducing healthcare-associated infections incidence by a probiotic-based sanitation system: a multicentre, prospective, intervention study","volume":"13","author":"Caselli","year":"2018","journal-title":"PLoS One"},{"key":"2020040813153252000_CIT0017","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1001\/jama.2018.12512","article-title":"Effect of levofloxacin prophylaxis on bacteremia in children with acute leukemia or undergoing hematopoietic stem cell transplantation: a randomized clinical trial","volume":"320","author":"Alexander","year":"2018","journal-title":"JAMA"},{"key":"2020040813153252000_CIT0018","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJM199907293410501","article-title":"A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy","volume":"341","author":"Freifeld","year":"1999","journal-title":"N Engl J Med"},{"key":"2020040813153252000_CIT0019","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.bbmt.2014.12.038","article-title":"Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen","volume":"21","author":"Sanz","year":"2015","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0020","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/tid.12175","article-title":"Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations","volume":"16","author":"Blennow","year":"2014","journal-title":"Transpl Infect Dis"},{"key":"2020040813153252000_CIT0021","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s00277-019-03755-2","article-title":"Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study","volume":"98","author":"Czy\u017cewski","year":"2019","journal-title":"Ann Hematol"},{"key":"2020040813153252000_CIT0022","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1086\/662376","article-title":"Moving CLABSI prevention beyond the intensive care unit: risk factors in pediatric oncology patients","volume":"32","author":"Kelly","year":"2011","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020040813153252000_CIT0023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/ice.2017.236","article-title":"Pathogen distribution and antimicrobial resistance among pediatric healthcare-associated infections reported to the National Healthcare Safety Network, 2011-2014","volume":"39","author":"Lake","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2020040813153252000_CIT0024","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijid.2018.09.012","article-title":"Bloodstream infections in oncology patients at Red Cross War Memorial Children\u2019s Hospital, Cape Town, from 2012 to 2014","volume":"77","author":"Mvalo","year":"2018","journal-title":"Int J Infect Dis"},{"issue":"10","key":"2020040813153252000_CIT0025","doi-asserted-by":"crossref","first-page":"e26537","DOI":"10.1002\/pbc.26537","article-title":"Comparing catheter-related bloodstream infections in pediatric and adult cancer patients","volume":"64","author":"Zakhour","year":"","journal-title":"Pediatr Blood Cancer"},{"key":"2020040813153252000_CIT0026","doi-asserted-by":"crossref","first-page":"421","DOI":"10.4161\/viru.21282","article-title":"Intrinsic and acquired resistance mechanisms in enterococcus","volume":"3","author":"Hollenbeck","year":"2012","journal-title":"Virulence"},{"key":"2020040813153252000_CIT0027","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1038\/sj.bmt.1705113","article-title":"Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation","volume":"36","author":"Dvorak","year":"2005","journal-title":"Bone Marrow Transplant"},{"key":"2020040813153252000_CIT0028","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1097\/INF.0b013e3182737427","article-title":"Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates","volume":"31","author":"Steinbach","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"2020040813153252000_CIT0029","doi-asserted-by":"crossref","first-page":"4745","DOI":"10.1002\/cncr.24507","article-title":"Candidemia in patients with hematologic malignancies in the era of new antifungal agents (2001-2007): stable incidence but changing epidemiology of a still frequently lethal infection","volume":"115","author":"Sipsas","year":"2009","journal-title":"Cancer"},{"key":"2020040813153252000_CIT0030","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1093\/jpids\/pix022","article-title":"Voriconazole dosing in children younger than 3 years undergoing cancer chemotherapy or hematopoietic stem cell transplantation","volume":"7","author":"Yan","year":"2018","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2020040813153252000_CIT0031","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1093\/cid\/cir492","article-title":"Infections in patients with hematologic neoplasms and hematopoietic stem cell transplantation: neutropenia, humoral, and splenic defects","volume":"53","author":"Safdar","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020040813153252000_CIT0032","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.idc.2010.01.010","article-title":"Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology","volume":"24","author":"Wingard","year":"2010","journal-title":"Infect Dis Clin North Am"},{"key":"2020040813153252000_CIT0033","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.bbmt.2013.01.022","article-title":"Defining incidence, risk factors, and impact on survival of central line-associated blood stream infections following hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome","volume":"19","author":"Lukenbill","year":"2013","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0034","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1046\/j.1365-2141.2003.04792.x","article-title":"Kinetics of myeloid and lymphocyte recovery and infectious complications after unrelated umbilical cord blood versus HLA-matched unrelated donor allogeneic transplantation in adults","volume":"124","author":"Hamza","year":"2004","journal-title":"Br J Haematol"},{"key":"2020040813153252000_CIT0035","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.bbmt.2005.01.010","article-title":"Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients","volume":"11","author":"Narimatsu","year":"2005","journal-title":"Biol Blood Marrow Transplant"},{"key":"2020040813153252000_CIT0036","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/tid.12345","article-title":"Risk factors for pre- and post-engraftment bloodstream infections after allogeneic hematopoietic stem cell transplantation","volume":"17","author":"Kikuchi","year":"2015","journal-title":"Transpl Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaa093\/32907029\/ofaa093.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/7\/4\/ofaa093\/33026683\/ofaa093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/7\/4\/ofaa093\/33026683\/ofaa093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,8]],"date-time":"2020-04-08T17:16:13Z","timestamp":1586366173000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaa093\/5805489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,16]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaa093","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2020,3,16]]},"article-number":"ofaa093"}}