Analysis of early infectious complications in pediatric patients undergoing bone marrow transplantation

Abstract

The purpose of the present study was to analyze the characteristics of infectious complications occurring during the first 100 days after bone marrow transplantation (BMT) in a cohort of 123 pediatric patients with hematological malignancies (n = 73), solid tumors (n = 32) and nonmalignant disorders (n = 18). Fifty-eight patients received allogeneic grafts, and 65 patients an autologous transplant. Fever developed in 107 (87%) children; 82% of infectious complications occurred during the neutropenic period. Documented infection developed in 33 (31%) patients, while 74 (69%) patients had possible infection (i.e. fever of unknown origin). The incidence of bacteremia was 21%, and gram-positive cocci were the predominant pathogens; non-bacteremic microbiologically documented infection developed in 6% of patients; clinically evident infection developed in 4% of subjects. The incidence of primary febrile episodes was not significantly different between autologous and allogeneic BMT (86% vs 88%); nor did the median number of days to the onset of fever (5 days in both groups) or the median duration of fever (5 days in both groups) differ. In contrast, the frequency of secondary febrile episodes was significantly higher (P = 0.0001) in allogeneic BMT recipients (40%) than in autologous recipients (15%). The mortality rate due to infections was 2/36 (5%) for matched sibling donor BMT, and 1/13 (8%) for matched unrelated donor BMT. No deaths occurred in the 65 patients who were autografted. Invasive fungal infections accounted for 2 of the 3 infectious deaths. In conclusion, the majority of children undergoing BMT experienced at least one infectious episode; allogeneic BMT recipients were at high risk of developing secondary febrile episodes, but the overall mortality rate due to infection in the first 100 days after transplantation was low.

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

“…30 The most common infection after HSCT is BSI, occurring in 13-60% of HSCT recipients. 1,[4][5][6][7][8] The source of most BSI is likely the skin, the oral mucosa or the gastrointestinal tract. 31 In the current study, the source of Figure 2 Multivariable analysis of predictors of BSI after HSCT.…”

“…1,2 It has been observed to occur in 13-60% of HSCT recipients. 1,[3][4][5][6][7][8][9][10] The differences in findings of these studies is likely due to factors such as different study designs, study populations, conditioning regimens and prophylactic antibiotic protocols. However, essentially all of the studies cited demonstrated that Gram-positive organisms, particularly coagulase-negative staphylococci and viridans group streptococci, were responsible for most BSI after HSCT.…”

Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies

“…Another aspect of this restriction is the unavailable comparison with published international CA-BSI rates because these rates refer to the common catheter-days. However, over 70% to 80% of nosocomial infections occur during neutropenic episodes [4,29]. Hence, due to the restriction to high risk days-the neutropenic days-it is a time-saving effective method for surveillance of nosocomial infections among neutropenic patients.…”

“…A special high risk patient group for CA-BSIs are the hematological oncology patients, because nearly 100% of these patients require indwelling central venous catheters for therapy and keep them during neutropenic episodes. Eighty-two percent of all infectious complications in patients undergoing hematopoietic stem cell transplantation appear during the neutropenic phase [4]. In addition, 65% of catheter-associated infectious episodes occur during neutropenia in recipients of bone marrow transplants [5].…”

Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation

“…Several retrospective pediatric reviews have reported incidence rates of documented IFI ranging from 6 to 12%, with overall mortality rates of 4-14%. [7][8][9] Many patients in need of allogeneic HCT have undergone intensive pre-transplant chemotherapy regimens and have experienced a prior IFI. Although several case series describe the outcome of adults with prior IFI who undergo HCT, [10][11][12][13] there are only sporadic case reports in the pediatric population.…”