We aimed to analyze infections in children undergoing hematopoietic stem cell transplantation (HSCT) until engraftment. The spectrum and risk factors associated will help plan interventions to reduce mortality. We performed a retrospective analysis on the infections, associated risk factors, and mortality until engraftment in children up to 18 years of age undergoing HSCT from January 2017 to August 2020. A total of 399 children were included, with a male: female ratio of 1.9:1, with matched related donor HSCT in 36.6%, a matched unrelated donor in 18.3%, and haploidentical HSCT in 38.1% of children. Culture positive bacteremia was documented in 22.1% transplants with gram-negative bacteria (GNB) isolated in 71/88 (80%). Among the GNB, the predominant organism was Klebsiella pneumonia in 38 (53%), E.coli in 16 (22%), Pseudomonas in 9 (12%). Carbapenem resistance was documented in 24/71 (33%). The incidence of possible, probable, and proven fungal infections in the cohort was 63 (15%), 28 (7%), and 6 (1.5%), respectively. Mortality up to engraftment due to sepsis in our cohort is 3.3% (n = 13). There was a significant association between mortality and a perianal focus (30.8%, p value 0.029) and the presence of carbapenem resistance (38%, p value 0.002). Mortality among those who developed proven fungal infections was significantly higher than those with bacteremia (p value 0.004). Our study has identified fungal sepsis and carbapenem-resistant GNB sepsis as high-risk groups for mortality. Risk directed interventions in these groups would help ensure survival and optimal outcomes.

我们的目的是分析接受造血干细胞移植 (HSCT) 直至植入的儿童的感染情况。相关的谱系和风险因素将有助于规划干预措施以降低死亡率。我们对2017年1月至2020年8月接受HSCT的18岁以下儿童的感染、相关危险因素和植入前死亡率进行了回顾性分析。共纳入399名儿童，男女比例为1.9 ：1，匹配的相关供体 HSCT 占 36.6%，匹配的无关供体占 18.3%，半相合 HSCT 占 38.1% 的儿童。在 71/88 (80%) 中分离出革兰氏阴性菌 (GNB) 的移植物中，有 22.1% 的移植物出现培养阳性菌血症。 GNB中，主要病原菌为肺炎克雷伯菌，占38例（53%），大肠杆菌占16例（22%），假单胞菌占9例（12%）。碳青霉烯类耐药性的记录为 24/71 (33%)。该队列中可能、可能和已证实的真菌感染的发生率分别为 63 例 (15%)、28 例 (7%) 和 6 例 (1.5%)。在我们的队列中，败血症导致植入前的死亡率为 3.3% (n = 13)。死亡率与肛周病灶（30.8%， p值 0.029）和碳青霉烯类耐药性（38%， p值 0.002）之间存在显着相关性。已证实发生真菌感染的患者的死亡率显着高于菌血症患者（ p值 0.004）。我们的研究已将真菌脓毒症和碳青霉烯类耐药 GNB 脓毒症确定为死亡高危人群。对这些群体进行风险导向的干预措施将有助于确保生存和最佳结果。