[Analysis of hospital associated infection characteristics in pediatric patients undergoing hematopoietic stem cell transplantation].

Objective

To analyze the characteristics of hospital associated infection (HAI) in children undergoing hematopoietic stem cell transplantation (HSCT).

Methods

The clinical data of children who underwent HSCT at Baoding Hospital, Beijing Children's Hospital Affiliated to Capital Medical University and Beijing Children's Hospital Affiliated to Capital Medical University between July 2021 and August 2024 were retrospectively collected. Based on the occurrence of HAI, the patients were divided into the infected group (children who developed at least one HAI during hospitalization) and the uninfected group (children who did not develop HAI during multiple hospitalizations). The characteristics of HAI in the two groups were analyzed.

Results

A total of 651 patients were enrolled, including 138 patients (21.2%) in the infected group [93 males and 45 females; aged 8 (4, 12) years] and 513 patients in the uninfected group [328 males and 185 females; aged 7 (4, 11) years]. The infected group had 181 cases of HAI occurring during 150 hospitalizations among 138 pediatric patients. The incidence rate of HAI was 8.4% (episode incidence rate 10.1%), and the daily incidence rate of HAI was 3.3‰ (4.0‰). The mortality rate in the infected group was higher than that in the uninfected group [6.5% (9/138) vs 0.6% (3/513), P<0.001]. The top five HAI were gastrointestinal infections (41.4%), vascular catheter-related bloodstream infections (19.3%), bloodstream infections (non catheter-related, sepsis type, 12.2%), lower respiratory tract infections (8.3%), and upper respiratory tract infections (6.6%). A total of 179 pathogenic microorganisms were detected in 181 cases of HAI in the infected group. The proportion of viruses in gastric intestinal infection accounted for 76.0% (57/75). The proportion of bacteria in catheter-related bloodstream infections was 100.0% (35/35), while in septic-type bloodstream infections it accounted for 90.1% (20/22). Lower respiratory tract infections were caused by bacteria and viruses in equal proportions, each accounting for 29.4% (5/15). The proportion of viruses in upper respiratory tract infections accounts for 91.7% (11/12), and bacteria accounted for 68.2% (15/22) of other infections. The median hospitalization duration for HAI was 21 (11, 38) days, with statistically significant difference in the timing of infection occurrence across various infection sites (Z=20.09, P=0.001). A total of 117 cases (64.6%) of HAI were treated with antimicrobial agents, with a median duration of antimicrobial use of 7 (0, 18) days. There was a statistically significant difference in the duration of antibiotic use among different infection sites (Z=84.10, P<0.001).

Conclusions

The children with HAI have a higher mortality rate. Viral gastrointestinal infections are the most common type of HAI, followed by bacterial bloodstream infections; the timing of infection occurrence and the duration of antimicrobial use vary across different infection sites.