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    Antimicrobial Lock Therapy: Is it a Real Savior in Pediatric Hematopoetic Stem Cell Transplant (HSCT) Patients?
    (Turkish Society of Haematology, 2025) Kara, Manolya; Sürçü, Murat; Adaklı Aksoy, Başak; Zengin Ersoy, Gizem; Başoğlu Öner, Özlem; Yaman, Ayhan; Özbek, Ahmet; Bozkurt, Ceyhun; Fışgın, Tunç
    Objective: Central line-associated bloodstream infection (CLABSI) is a significant cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Antimicrobial lock treatment (ALT), when utilized alongside systemic antibiotics, may be lifesaving when catheter removal (CR) is not feasible. Materials and methods: This retrospective study analyzed the clinical, laboratory, and microbiologic characteristics of CLABSI episodes of pediatric patients who underwent HSCT and applied ALT. Results: There were 137 cases of CLABSI (63.5 male) who were given ALT. The median age was 48 (3-204) months. The most common causative microorganism was Gram-negative bacteria, encountered in 85 patients (62%). Forty-six patients (33.6%) had Gram-positive bacterial growth, whereas 6 had (4.4%) fungal infection. ALT was successful in 77.4% of the patients (n=106). CR was required in 25 patients (18.2%). The CLABSI-related mortality rate was 12.4%. When the outcome of ALT was evaluated, post-transplantation cyclophosphamide (PTCy) use, fungal growth, persistent bacteremia/fungemia, re-HSCT, inappropriate empirical antibiotic use, hypotension, and pediatric intensive care unit admission were significantly more common in the "unsuccessful" ALT group. The patients in the unsuccessful group had higher C-reactive protein [110.2 (1.10-323.5) mg/L] levels when compared to the successful ALT group [58 (0.2-450.3) mg/L] (p=0.029). The presence of hypotension, HLA-mismatch transplantation, and persistent bacteremia/fungemia were independent risk factors for ALT failure. Conclusion: ALT can be an effective catheter-saving strategy in HSCT pediatric patients. Nevertheless, patients should be monitored very closely during ALT, and the presence of certain risk factors should be taken into account.
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    Öğe
    Epidemiologic and microbiologic evaluation of catheter-line bloodstream infection in a pediatric hematopoietic stem cell transplant center
    (2023) Adaklı Aksoy, Başak; Kara, Manolya; Sütçü, Murat; Özbek, Ahmet; Zengin Ersoy, Gizem; Başoğlu Öner, Özlem; Aydoğdu, Selime; Gül, Doruk; Bozkurt, Ceyhun; Fışgın, Tunç
    Background: Children who underwent hematopoietic stem cell transplant (HSCT) are at high risk of developing central-line-associated bloodstream infection (CLABSIs). The present study aimed to identify possible risk factors for mortality by analyzing the clinical and laboratory characteristics of patients diagnosed with CLABSI in our pediatric HSCT unit. Methods: The initial CLABSI episodes of 102 children were analyzed. Medical records of the patients were evaluated by preformed standardized surveys. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for mortality. Results: Thirty-five patients (34.3%) were female. The median age was 48 month (3-204). The median time to onset of CLABSI was 19 days (4-150). The Gram-negative/Gram-positive bacteria ratio among the causative agents was 57.8 % to 34.3 %. The mortality rate was 12.6%. The presence of severe neutropenia, initiation of inappropriate empirical antibiotic therapy, the presence of hypotension, persistent bacteremia, pediatric intensive care unit admission, growth of carbapenemase-positive Gram-negative microorganism and multi-drug resistant bacteria were significantly high in the mortality group when compared to survivors. The presence of hypotension, inappropriate empirical antibiotic therapy, and persistent bacteremia were found to be independent risk factors for mortality. Conclusion: Rational use of antibiotics, active surveillance/ screening of patients together with improved infection control practices may reduce the incidence and the consequences of CLABSIs.