[Analysis of Risk Factors for Bloodstream Infections in Children with Aplastic Anemia after Allogeneic Hematopoietic Stem Cell Transplantation].

内容摘要

To investigate the clinical characteristics, pathogenic distribution, and risk factors of bloodstream infection (BSI) in children with aplastic anemia (AA) following allogeneic hematopoietic stem cell transplantation (allo-HSCT), to provide clinical evidence for the early identification of high-risk patients and optimization of empirical antibacterial therapy regimens. The clinical data of 113 children with AA who underwent allo-HSCT at the Pediatric Hematology and Oncology Center of Wuhan Children's Hospital from August 2016 to December 2024 were retrospective collected. The incidence of bloodstream infection, pathogenic distribution, and identify relevant risk factors in these patients was analyzed. Among the 113 children with AA, 23 cases (20.4%) developed bloodstream infection after allo-HSCT. A total of 26 pathogenic strains were isolated, including 13 Gram-negative strains (50.0%), 10 Gram-positive strains (38.5%), and 3 fungal strains (11.5%). The most commonly detected pathogenic bacteria were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, with the detection rate of carbapenem-resistant Gram-negative organisms (CRO) reaching 26.1%. Multivariate analysis indicated that active infection prior to transplantation (HR=3.749, 95%CI:1.398-10.055, P=0.009) was an independent risk factor for post-transplant BSI. Moreover, the OS rate of children with agranulocytosis duration >17 days was significantly lower than that of those with agranulocytosis duration ≤17 days. Gram-negative bacteria are the predominant pathogens causing bloodstream infection in children with AA following allo-HSCT. Additionally, the presence of active infection prior to transplantation was identified as an independent risk factor for post-transplant BSI. 儿童再生障碍性贫血异基因造血干细胞移植后血流感染的危险因素分析. 分析儿童再生障碍性贫血（AA）接受异基因造血干细胞移植（allo-HSCT）后血流感染（BSI）的临床特征、病原学分布及危险因素，为早期识别高危患者、优化经验性抗菌治疗方案提供临床依据. 回顾性收集2016年8月至2024年12月期间武汉儿童医院小儿血液肿瘤中心接受allo-HSCT治疗的113例AA患儿临床资料。分析患儿血流感染的发生率、病原菌分布，并筛选相关危险因素. 113例AA患儿中，有23例（20.4%）allo-HSCT移植后发生血流感染，共检出病原菌26株，分别为革兰阴性菌13株（50.0%）、革兰阳性菌10株（38.5%）和真菌3株（11.5%）。检出的常见致病菌为肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌，耐碳青霉烯类革兰阴性菌（CRO）的检出率为 26.1%。多因素分析结果显示，移植前存在活动性感染(HR＝3.749, 95%CI： 1.398-10.055, P＝0.009)为移植后发生血流感染的独立危险因素。粒缺持续时间>17 d的患儿总生存率显著低于粒缺持续时间≤17 d的患儿. AA患儿allo-HSCT后血流感染病原菌以革兰氏阴性菌为主，移植前存在活动性感染是移植后发生血流感染的独立危险因素.