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.
abstract: There are only few reports describing the influence of central line-associated bloodstream infection (CLABSI) prevention strategies on the incidence of bacterial bloodstream infections (BBSIs).
  
  
  
  We performed a retrospective cohort study among pediatric recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT) to assess potential changes in BBSI rates during 3 time periods: pre-CLABSI prevention era (era 1, 2004-2005), CLABSI prevention implementation era (era 2, 2006-2009), and maintenance of CLABSI prevention era (era 3, 2010-2012). BBSI from day 0-365 following allo-HCT were studied. The comparison of person-years incidence rates among different periods was carried out by Poisson regression analysis.
  
  
  
  The mean age of patients was 10.0 years. During the study period, 126 (65%) of 190 patients had at least a single BBSI. From day 0-30, day 31-100, day 101-180, and day 181-365, 20%, 28%, 30%, and 17% of patients, respectively, experienced BBSIs. The rate of Staphylococcus epidermidis and gram-negative pathogens significantly declined from 3.16-0.93 and 6.32-2.21 per 100 person-months during era 1 and era 3, respectively (P = .001).
  
  
  
  Patients undergoing allo-HCT during era 3 were associated with decreased risk of BBSI (P = .012). Maintenance of CLABSI protocols by nursing staff and appropriate education of other care providers is essential to lower incidence of BBSI in this high-risk population, and further strategies to decrease infection burden should be studied.
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Foca
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Rahul
authors.initials: R
authors.lastname: Vasudev
authors.affiliation: Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
authors.forename: Mary
authors.initials: M
authors.lastname: Laird
authors.affiliation: Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
authors.forename: Sharon
authors.initials: S
authors.lastname: Schwartz
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Mahvish
authors.initials: M
authors.lastname: Qureshi
authors.affiliation: Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kolb
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Anya
authors.initials: A
authors.lastname: Levinson
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kung
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Garvin
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Diane
authors.initials: D
authors.lastname: George
authors.affiliation: Department of Pathology, Columbia University, New York, NY.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.affiliation: Department of Pathology, Columbia University, New York, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Whittier
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY; Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY. Electronic address: ps2087@columbia.edu.
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D066027:Transplant Recipients; D014184:Transplantation, Homologous
keywords: Bone marrow transplantation; Children; Sepsis