Incidence and risk factors of bacterial infections in children following autologous hematopoietic stem cell transplantation: Single‐center experience from Jordan

Abstract

Bacterial infection is a serious sequela following AHSCT; however, limited data are available regarding pediatric recipients, especially in developing countries. We retrospectively analyzed the incidence and risk factors of bacterial infections during the first 100 days after AHSCT in children at KHCC in Amman, Jordan between January, 2005 and September, 2013. A total of 65 patients were identified, with median age of four yr (1-17). Forty-seven patients (72.3%) had solid tumors and 18 (27.7%) had lymphoma. Bacterial infections were documented in 33 patients (50%), with a total of 63 episodes. Gram-negative infection (57.1%) was more prevalent than Gram-positive infection (38%). The risk of bacterial infections was higher among patients less than five yr of age (p = 0.028) and those who developed hypogammaglobulinemia requiring IVIG replacement (p = 0.001). Patients with solid tumors developed more bacterial infections compared to patients with lymphoma (p = 0.0057). No deaths were attributed to bacterial infection. Bacterial infection rate is high among recipients of AHSCT in Jordan with Gram-negative bacteria being the most common.

Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014

“…A study conducted in Johannesburg investigating infections from 1991 to 1995 documented a CFR of 8.5%, whereas a recent study conducted in Qatar over a study period of 2004 to 2011 recorded a CFR of 2.2% (Van de Wetering et al, 2001;Al-Mulla et al, 2014). Furthermore, a study of infectious complications in children with AML and Down syndrome reported no deaths from bacterial or fungal infections (Hussein et al, 2016). The low mortality at RCWMCH may reflect an aggressive approach to monitoring BSI in oncology patients, lower resistance rates of microbial isolates, and the short median time to initiating effective antimicrobial therapy of 0 days.…”

Infection surveillance in pediatric hematopoietic stem cell transplantation recipients

“…This may be attributed to the intense myeloand immunosuppression caused by the HSCT preparative regimen, which leads to the development of disease by otherwise less virulent microorganisms. In a retrospective study, Hussein et al 10 were the most commonly observed. A national study also showed a similar proportion of GNB (46.8%), but coagulase-negative staphylococci were the most prevalent.…”

“…17 Invasive fungal disease by Aspergillus is said to be proven when: (i) the presence of hyphae is associated with evidence of tissue invasion observed on histopathological, cytopathological, or microscopic examination of a specimen obtained by aspiration or biopsy; (ii) there is recovery of filamentous fungi in a culture specimen obtained from a sterile site, associated with clinical or radiological changes consistent with an infectious process. 18 An institutional statistical software package designed by our local HICC for epidemiological surveillance was used for the study data- Median age in years (IQ25%-75%) 10 The same patient may have used more than one catheter at a time.…”

“…7,8 Other associated factors can influence the development of infectious complications in these patients, such as central venous catheters (CVCs), presence of comorbidities, intensity and duration of neutropenia, mucositis, and use of antimicrobial prophylaxis. 9,10 It has long been known that CVC-associated infections in cancer patients are related to a sevenfold increase in mortality rates in this population. 11 Although HSCT has been performed since the late 1970s in Brazil, few studies have thus far addressed its distinctive infectious features and complications in children and adolescents in our country.…”

“…Other associated factors can influence the development of infectious complications in these patients, such as central venous catheters (CVCs), presence of comorbidities, intensity and duration of neutropenia, mucositis, and use of antimicrobial prophylaxis . It has long been known that CVC‐associated infections in cancer patients are related to a sevenfold increase in mortality rates in this population .…”