Early bacterial and fungal infection in children receiving allogeneic stem cell transplantation for acute lymphoblastic leukemia in Argentina

Abstract

Infections are important complications associated with allogeneic HSCT. Describing infection rates in low- and middle-income countries provides data to infer efficacy of supportive care practices in these settings. In this retrospective cohort study, we included patients (age ≤ 18 years) who underwent a first allogeneic HSCT for ALL in a single center in Argentina between 1998 and 2016. The primary outcome was sterile site bacterial infection. Secondary outcomes were proven or probable invasive fungal infection, TRM, and infectious deaths. There were 68 allogeneic HSCT recipients with ALL included in this analysis. Overall, 17 (25.0%) experienced at least one sterile site bacterial infection and 10 (14.7%) experienced at least one proven or probable invasive fungal infection. The TRM rate was 19.1%, and 3 (4.4%) patients died of infection. In a middle-income country center in Argentina, pediatric allogeneic HSCT infection rates, TRM, and infection-related mortality were comparable to high-income countries. These data support continuation of allogeneic HSCT programs in similar resource-limited settings provided that adequate supportive care and monitoring of outcomes can be performed.

New Perspectives on Primary Prophylaxis of Invasive Fungal Infection in Children Undergoing Hematopoietic Stem Cell Transplantation: A 10-Year Retrospective Cohort Study

“…The rate of IFIs during the first year post-a-HCT in our study was consistent with the literature, generally reported between 5 and 25% in a similar pediatric population [4][5][6][7][8][9][10][11][12][13][14]. However, in their recent study of 290 pediatric patients with a median age similar to our cohort, Dvorak et al reported an IFI incidence of 1.2% among patients who benefited from systematic primary prophylaxis with an azole (fluconazole or voriconazole) or echinocandins during the time until discharge from hospital for HCT, which represents only one of the periods of risk for developing IFI [15].…”

“…As a reminder, only 7.5% of our patients received primary antifungal prophylaxis and 8.8% received secondary prophylaxis. Our IFI-related mortality rate was lower than those reported in other studies (60% to 80%) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 33 , 34 ]. This study reinforces the hypothesis that not systematizing antifungal prophylaxis in a-HCT pediatric patients could be performed.…”

“…Invasive fungal infections (IFIs) have emerged as important causes of morbidity and mortality. Indeed, the incidence rate reported for IFIs varies from 1.2% to 25% depending on the study, with a mortality rate that can reach 80% in the most severe forms [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. In these patients, infections with Candida and Aspergillus species are the most common, even if mucormycosis have emerged as increasingly relevant and highly lethal causes of IFIs in many centers worldwide [ 16 , 17 , 18 ].…”

Treatment of severe infectious complications caused by multidrug-resistant Klebsiella pneumoniae in children with malignant neoplasms of the hematopoietic system: experience of the Research Institute of Pediatric Oncology and Hematology at N.N. Blokhin Russian Cancer Research Center

“…Частота развития грамотрицательных инфекций у детей со ЗНО при проведении ПХТ и ТГСК значимо варьирует и составляет от 7 до 70 % в зависимости факторов риска [4,6,10,11]. Из них до трети пациентов умирают от этих инфекционных осложнений [5,6,12].…”

“…Наиболее тяжело протекают инфекции у детей после ТГСК, связанные с K. pneumoniae c МЛУ, которые встречаются с частотой от 2 до 18 % [2, 4-6, 11, 12], смертность при этом достигает 60 % [5,6,12,14,15]. Неблагоприятный исход возникает вследствие колонизации c последующим развитием катетер-ассоциированной инфекции кровотока микроорганизмом, обладающим МЛУ [4].…”