Unlike previously published series based on tumor registries, benign teratoma was the most common pediatric testicular tumor treated at our institution. Our single institution experience with testis preservation and long-term followup confirms the role and safety of this technique. Testis sparing surgery remains our technique of choice for testicular teratoma.

Recent publications note an association between antibiotic exposure and respiratory viral infections (RVIs). Antibiotics affect microbiota and impair immune response against RVIs in mice, and low microbiome diversity is associated with pulmonary complications including viral lower respiratory tract disease (LRTD) in hematopoietic cell transplantation (HCT) recipients. In this study, we examined whether antibiotic exposure was associated with increased risk of disease progression in RVIs post-transplantation. We analyzed patients who underwent allogeneic HCT (June 2008 to February 2016) and had their first RVI due to parainfluenza virus (PIV), respiratory syncytial virus (RSV), or human metapneumovirus (MPV) during the initial 100 days post-transplantation. Antibiotic exposure in the 3 weeks before RVI onset was defined as (1) use of specific antibiotics versus none of these antibiotics and (2) number of antibiotic-days. Cox proportional hazards models were used to examine associations between antibiotic exposures and risk of viral disease progression to proven/probable/possible LRTD. Ninety HCT recipients (84 adults, 6 children) fulfilled study criteria; 33 progressed to LRTD. The number of antibiotic-days was associated with progression to LRTD after adjusting for neutropenia, steroid use, and either lymphopenia (hazard ratio, 1.41 [95% confidence interval, 1.04 to 1.92], P = .027) or monocytopenia (hazard ratio, 1.46 [95% confidence interval, 1.11 to 1.91], P = .006). Specific antibiotic classes was not associated with the outcome. Cumulative antibiotic exposure immediately before RVI onset is a risk factor for disease progression following PIV, RSV, and MPV infections post-transplantation. Larger cohort studies are needed to determine the impact of specific antibiotics or antibiotic classes on disease severity.

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Introduction: Infection remains a dominant source of morbidity/mortality for patients undergoing myeloablative chemotherapy and autologous stem cell transplant (ASCT). We sought to determine the relative risk of infection with the use of packed red blood cell (pRBC) transfusion to treat chemotherapy associated anemia. Methods: Patients who underwent ASCT at Pennsylvania Hospital between 1995 and 2019 were identified. Data on transfusion status and infection were obtained from patient discharge and transplant summary forms including: Participation in bloodless medicine program, number of units of pRBCs transfused, and documented post-transplant infection. Standard 2 variable relative risk analysis and odds ratio were calculated to assess association between transfusion use and post-transplant infection rate. Results: 306 patients were identified to have undergone ASCT with 176 (57.7%) participating in the bloodless medicine program, 46 (15.1%) having no need of pRBC, and 83 (27.1%) receiving at least 1 unit of pRBC. Median number of pRBC in transfused patients was 2 units. Rate of infection among those who did not receive pRBC was 33.3% while it was significantly higher in those who did at 49.4%. Patients who received pRBC were at higher risk of developing infection (Relative risk (RR) 1.48, odds ratio (OR) 1.95, 95% confidence interval (CI) 1.17-3.26, p=0.01) than those who did not. Further analysis showed that higher quantity of pRBC units further increased infection risk in patients who got 4 or more units of pRBC (RR=1.97, OR=4.14, CI=1.814-9.450, P=.0007). Conclusion: Infection after ASCT was more common with the use of pRBC transfusion to treat anemia while number of pRBC units was positively correlated with rates of infection. This area needs further study to better plot timelines of events as well multiple regression analysis to control for confounding variables such as relative levels of neutropenia before onset of infection. Disclosures No relevant conflicts of interest to declare.