Infectious complications after allogeneic hematopoietic stem cell transplantation in children in a bone marrow transplant unit in Colombia

Abstract

Objective There is a relative lack of information about infections occurring in children following allogeneic hematopoietic stem cell transplants (allo‐HSCT) in developing countries. Herein, we describe the incidence rates of different infections according to the transplant period and baseline condition in Colombia. Methods In a retrospective cohort study of all children who underwent allo‐HSCTs from 2012 to 2017 in a hospital in Cali, Colombia, we reviewed medical records from the first post‐transplant day until day + 365 to describe microbiologically confirmed incidence rates of infections and deaths during three post‐transplant periods and according to baseline condition. Results Most allo‐HSCT (n = 144, 96%) were followed by infections over the following year, mostly due to bacteria and cytomegalovirus (4.3 and 3.3 per 1000 patient‐days, respectively). Children were at the highest risk for infection in the first 30 days post‐HSTC, but mortality was highest after 100 days. Overall, high mortality (n = 44, 31.7%) was associated with infections, especially from extensively drug‐resistant bacteria, adenovirus, and aspergillosis. Infection rates were similar independent of the baseline condition. Conclusion Almost all children in this cohort developed infections post allo‐HSCT. Describing the distribution of infections throughout the first post allo‐HSCT year allows clinicians to narrow the differential diagnosis of infections according to the post‐transplant period. This is especially useful when prioritizing interventions in children receiving HSCT in stringent healthcare systems in developing countries.

Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study

“…The growing number of children with a weakened immune system has led to a high frequency of bloodstream infection (BSI) worldwide. 6 , 7 These patients have a high risk of mortality, which worsens when inappropriate empirical antibiotics are used, especially for Gram-negative pathogens. 8 Given that antibiotics against CRE are not routinely used empirically in immunocompromised children, 9 identifying the risk factors of CRE in children who have findings suggestive of BSI is crucial to guide empirical therapy and reduce negative short- and long-term outcomes, including mortality.…”