Pediatric Transplantation. 2019;00:e13610. wileyonlinelibrary.com/journal/petr | 1 of 11 https://doi.org/10.1111/petr.13610 © 2019 Wiley Periodicals, Inc. Received: 1 June 2019 | Revised: 6 September 2019 | Accepted: 30 September 2019 DOI: 10.1111/petr.13610 ORIGINAL ARTICLE Incidence, risk factors, and outcome of blood stream infections during the first 100 days post‐pediatric allogeneic and autologous hematopoietic stem cell transplantations Ahmed Youssef 1 | Hanafy Hafez 1,2 | Youssef Madney 1,2 | Mervat Elanany 3,4 | Omneya Hassanain 5 | Leslie E. Lehmann 6 | Alaa El Haddad 1,2 Abbreviations: Allo, Allogeneic; ANC, Absolute neutrophil count; Auto, Autologous; BD, Becton Dickinson; BeEAM, Bendamustine/etoposide/cytarabine/melphalan; BMT, Bone marrow transplant; BSI, Blood stream infection; BSI, bloodstream infection; BuCy, Busulfan/cyclophosphamide; BuMEL, Busulfan/melphalan; CCHE, Children Cancer Hospital Egypt; CEM, Carboplatin/etoposide/melphalan; CI, Confidence intervals; CML, Chronic myeloid leukemia; CMV, Cyclophosphamide/ melphalan/ etoposide; CMV, Cytomegalovirus; CoNS, Coagulase‐negative staphylococci; CR1, First complete remission; CR2, Second complete remission; CsA, Cyclosporine; CVL, Central venous line; CyTBI, Cyclophosphamide/total body irradiation; ESBL, Extended‐spectrum beta‐lactamase; FN, Fever neutropenia; GCSF, Granulocyte colony‐stimulating factor; GNB, Gram‐negative bacteria; GPB, Gram‐positive bacteria; GVHD, Graft‐versus‐host disease; HEPA, High‐efficiency particulate air; HLA, Human leukocyte antigen; HPCA, Hematopoietic progenitor cells—apheresis; HR, Hazard ratios; HSCT, Hematopoietic stem cell transplant; i.v., Intravenous; JMML, Juvenile myelomonocytic leukemia; LMIC, Low/middle‐income countries; MAC, Myeloablative conditioning; MDR, multidrug‐resistant bacteria; MDS, Myelodysplastic syndrome; MRD, Matched‐related donor; MRSA, Methicillin‐resistant staphylococcus aureus; MTX, Methotrexate; MUD, Matched‐unrelated donor; NB, Neuroblastoma; OS, Overall survival; PCR, Polymerase chain reaction; PICU, Pediatric intensive care unit; RIC, Reduced‐intensity conditioning; TBI, Total body irradiation; VRE, Vancomycin‐resistant enterococci. 1 Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt 2 Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt 3 Microbiology Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt 4 Clinical Pathology Department, Cairo University, Cairo, Egypt 5 Biostatistics and Epidemiology Unit, Research Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt 6 Pediatric Hematology‐Oncology and Stem Cell Transplantation Unit, Dana Farber/ Children's Hospital Cancer Care Center, Boston, MA, USA Correspondence Ahmed Youssef, Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), 1 Seket Al‐Emam Street ‐ El‐Madbah El‐Kadeem Yard ‐ Zeinhom ‐ El‐Saida Zenab ‐ Cairo Governorate – Children's Cancer Hospital Egypt 57357, Cairo, Egypt. Email: ahmed.mahdy@57357.com Abstract Bloodstream infections (BSI) are a frequently observed complication after hemat‐ opoietic stem cell transplant (HSCT). Retrospective analysis of clinical and microbio‐ logical data during the first 100 days from 302 consecutive pediatric patients who underwent HSCT for a malignant disease at our institute between January 2013 and June 2017. A total of 164 patients underwent autologous and 138 allogeneic HSCT. The overall incidence of BSI was 37% with 92% of infectious episodes occurring dur‐ ing the pre‐engraftment phase. Gram‐positive bacteria (GPB) accounted for 54.6% of the isolated pathogens, gram‐negative bacteria (GNB) for 43.9%, and fungi for 1.4%. Coagulase‐negative staphylococci and Escherichia coli were the most commonly isolated GPB and GNB, respectively. Forty‐five percent of GNB were extended‐ spectrum beta‐lactamase producers and 21% were multidrug‐resistant organisms. Fluoroquinolone resistance was 92% and 68%, among GPB and GNB, respectively. Risk factors for BSI in univariate analysis were allogeneic HSCT, delayed time to en‐ graftment more than 12 days, previous BSI before HSCT, and alternative donor. In multivariate analysis, only HSCT type (allogeneic vs autologous P = .03) and previ‐ ous BSI within 6 months before HSCT (P = .016) were significant. Overall survival at day 100 was 98% and did not differ significantly between patients with and without BSI (P = .76). BSI is common in children undergoing HSCT for malignant diseases. Allogeneic HSCT recipients and previous BSI within 6 months before HSCT are asso‐ ciated with increased risk of post‐transplant BSI. With current supportive measures, BSI does not seem to confer an increased risk for 100‐day mortality.