Abstract
We performed a retrospective single center study to define the epidemiology of bacteremias or invasive mycoses in pediatric allogeneic hematopoietic SCT (HSCT) from matched related donors (MRD) or alternative donors (AD). During 119 213 days of follow-up, 156 infections were observed: 130 bacteremias (27 in MRD-HSCT and 103 in AD-HSCT recipients) and 26 invasive mycoses (8 in MRD-HSCT and 18 in AD-HSCT recipients). Overall, the risk of bacteremia was fivefold that of invasive mycosis (P<0.001). AD-HSCT recipients had a higher percentage of infections (89 vs 27%; P<0.001), a higher rate/100 days of immunosuppression (infection rate (IR): 0.21 vs 0.06; P<0.001) and a higher proportion of repeated infections (44 vs 9%; P=0.001). In AD-HSCT, the relative risk of bacteremia was 2.87 in the pre-engraftment period, 5.84 in the early post-engraftment period and 6.46 in the late post-engraftment period (P<0.001) compared to MRD-HSCT. Only after 1 year did the epidemiology become similar. The epidemiology of invasive mycoses did not differ significantly between the two types of transplant.
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References
Sepkowitz KA . Risk and epidemiology of infections after allogeneic hemopoietic stem cell transplantation. In: Bowden RA, Ljungman P, Paya CV (eds). Transplant Infections. Lippincott Willians & Wilkins: Philadelphia, 2003, pp 31–38.
Deeg HJ, Bowden RA . Introduction to hemopoietic stem cell transplantation. In: Bowden RA, Ljungman P, Paya CV (eds). Transplant Infections. Lippincott Willians & Wilkins: Philadelphia, 2003, pp 3–16.
Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol 2001; 19: 2201–2205.
Fratino G, Molinari AC, Parodi S, Longo S, Saracco P, Castagnola E et al. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 2005; 16: 648–654.
Nucci M, Andrade F, Vigorito A, Trabasso P, Aranha JF, Maioliono A et al. Infectious complications in patients randomized to receive allogeneic bone marrow or peripheral blood transplantation. Transpl Infect Dis 2003; 5: 167–173.
Ninin E, Milpied N, Moreau P, Andre-Richet B, Morineau N, Mahe B et al. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001; 33: 41–47.
Barker JN, Hough RE, van Burik JA, DeFor TE, MacMillan ML, O'Brien ML et al. Serious infections after unrelated donor transplantation in 136 children: impact of stem cell source. Biol Blood Marrow Transplant 2005; 11: 362–370.
Martino R, Subira M, Rovira M, Solano C, Vasquez L, Sanz GL et al. Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients. Br J Haematol 2002; 116: 475–482.
Wald A, Leisenring W, van Burik JA, Bowden RA . Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997; 175: 1459–1466.
van Kraaij MG, Verdonck LF, Rozenberg-Arska M, Dekker AW . Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence. Bone Marrow Transplant 2002; 30: 303–309.
van Burik J, Weisdorf D . Infections in recipients of hematopoietic stem cell transplantation. In: Mandell GL, Bennett JE, Doolin R (eds). Principles and Practice of Infectious Diseases. Churchill Livingstone: Philadelphia, 2005, pp 3486–3501.
Junghanss C, Marr KA, Carter RA, Sandmaier BM, Maris MB, Maloney DG et al. Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study. Biol Blood Marrow Transplant 2002; 8: 512–520.
Viscoli C, Castagnola E . Prophylaxis and empirical therapy for infection in cancer patients. In: Mandell GL, Bennett JE, Doolin R (eds). Principles and Practice of Infectious Diseases. Churchill Livingstone: Philadelphia, 2005, pp 3442–3462.
Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.
Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB . Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003; 36: 1103–1110.
Franklin JA, Gaur AH, Shenep JL, HU XJ, Flynn PM . In situ diagnosis of central venous catheter-related bloodstream infection without peripheral blood culture. Pediatr Infect Dis J 2004; 23: 614–618.
Humphreys H . Positive-pressure isolation and the prevention of invasive aspergillosis. What is the evidence? J Hosp Infect 2004; 56: 93–100; quiz 163.
Raad I, Hanna H, Osting C, Hachem R, Umphrey J, Tarrand J et al. Masking of neutropenic patients on transport from hospital rooms is associated with a decrease in nosocomial aspergillosis during construction. Infect Control Hosp Epidemiol 2002; 23: 41–43.
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002; 23: 759–769.
Rodriguez M, Fishman JA . Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev 2004; 17: 770–782.
Cesaro S, Cecchetto G, Corti FD, Dodero P, Giacchino M, Caviglia I et al. Results of a multicenter retrospective study of a combined medical and surgical approach to pulmonary aspergillosis in pediatric neutropenic patients. Pediatr Blood Cancer 2006; 49: 909–913.
Bally F, Erard V, Vallet Y, Wenger A, Bille J, Calandra T ; et al. A 5-year survey of blood cultures (BC) results in febrile neutropenic cancer patients: excellent yield of sampling via non-tunneled central venous catheter (CVC) without peripheral venipuncture (PV). In: Program and Abstract of the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology: Washington, DC, 2003; abstract no. K 2037.
DesJardin JA, Falagas ME, Ruthazer R, Griffith J, Wawrose D, Schenkein D et al. Clinical utility of blood cultures drawn from indwelling central venous catheters in hospitalized patients with cancer. Ann Intern Med 1999; 131: 641–647.
Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R et al. Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplant 2005; 35: 737–746.
Castagnola E, Fioredda F . Prevention of life-threatening infections due to encapsulated bacteria in children with hyposplenia or asplenia: a brief review of current recommendations for practical purposes. Eur J Haematol 2003; 71: 319–326.
Sullivan KM . Graft-vs-Host Disease. In: Thomas ED, Forman SJ, Appelbaum FR, Blume KG (eds). Thomas's Hematopoieitc Stem Cell Transplantation. Blackwell Publishing Professional: London, 2004, pp 643–645.
Fitting models to grouped data. In: data Fmtg (ed). Statistical Methods in Cancer Research. International Agency for Research on Cancer: Lyon, 1987, pp 120–176.
Non parametric methods for the comparison of survival curves. In: Marubini EVM (ed). Analyzing Survival Data from Clinical Trials and Observational Studies. John Wiley & Sons Ltd: Chichester, UK, 1995, pp 91–137.
Cappellano P, Viscoli C, Bruzzi P, Van Lint MT, Pereira CA, Bacigalupo A . Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion. New Microbiol 2007; 30: 89–99.
Castagnola E, Cesaro S, Giacchino M, Livadiotti S, Tiucci F, Zanazzo G et al. Fungal infections in children with cancer: a prospective, multicenter surveillance study. Pediatr Infect Dis J 2006; 25: 634–639.
Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR . Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant 2007; 40: 63–70.
Boeckh M, Marr KA . Infection in hematopoietic stem cell transplantation. In: Rubin RH, Young LS (eds). Clinical Approach to Infection in the Compromised Host. Kluwer Academic/Plenum: New York, 2002, pp 527–571.
Benjamin DKJ, Miller WC, Bayliff S, Martel L, Alexander KA, Martin PL . Infections diagnosed in the first year after pediatric stem cell transplantation. Pediatr Infect Dis J 2002; 21: 227–234.
Ochs L, Shu XO, Miller J, Enright H, Wagner J, Filipovich A et al. Late infections after allogeneic bone marrow transplantations: comparison of incidence in related and unrelated donor transplant recipients. Blood 1995; 86: 3979–3986.
Marr KA, Carter RA, Crippa F, Wald A, Corey L . Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002; 34: 909–917.
Gafter-Gvili A, Fraser A, Paul M, Leibovici L . Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 2005; 142 (12 Part 1): 979–995.
Hovi L, Saarinen-Pihkala UM, Vettenranta K, Saxen H . Invasive fungal infections in pediatric bone marrow transplant recipients: single center experience of 10 years. Bone Marrow Transplant 2000; 26: 999–1004.
Hovi L, Saxen H, Saarinen-Pihkala UM, Vettenranta K, Meri T, Richardson M . Prevention and monitoring of invasive fungal infections in pediatric patients with cancer and hematologic disorders. Pediatr Blood Cancer 2007; 48: 28–34.
van Burik JH, Leisenring W, Myerson D, Hackman RC, Shulman HM, Sale GE et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal diseases in bone marrow transplant recipients with special attention to hepatic candidiasis. An autopsy study of 355 patients. Medicine (Baltimore) 1998; 77: 246–254.
Maertens JA, Frère P, Lass-Floer C, Heinz W, Cornely AO . Primary antifungal prophylaxis in leukaemia patients. Guidelines from the First European Conference on Infections. Eur J Cancer Suppl 2007; 5: 43–48.
Dvorak CC, Steinbach WJ, Brown JM, Agarwal R . Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2005; 36: 621–629.
De Pauw BE, Donnelly JP . Prophylaxis and aspergillosis—has the principle been proven? N Engl J Med 2007; 356: 409–411.
Castagnola E, Faraci M, Moroni C, Bandettini R, Granata C, Caruso S et al. Invasive mycoses in children receiving hematopoietic stem cell transplant. Bone Marrow Transpl Suppl (in press).
Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 2007; 356: 335–347.
Marr KA, Carter RA, Boeckh M, Martin P, Corey L . Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002; 100: 4358–4366.
Acknowledgements
The study was partially supported by grants from Fondazione CARIGE, Compagnia di S Paolo, Italian foundation for Research on Neuroblastoma and by Gaslini Children Hospital.
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Castagnola, E., Bagnasco, F., Faraci, M. et al. Incidence of bacteremias and invasive mycoses in children undergoing allogeneic hematopoietic stem cell transplantation: a single center experience. Bone Marrow Transplant 41, 339–347 (2008). https://doi.org/10.1038/sj.bmt.1705921
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DOI: https://doi.org/10.1038/sj.bmt.1705921
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