Invasive pneumococcal disease in adult hematopoietic stem cell transplant recipients: a decade of prospective population-based surveillance

Abstract

Prospective population-based surveillance to assess the epidemiology of invasive pneumococcal disease (IPD) in hematopoietic stem cell transplant (HSCT) patients is limited and a comparison to the general population is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance of IPD in a large cohort of adult HSCT patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 14 cases of IPD (based on sterile site isolates) in our HSCT population over a 10-year period. This translated to an incidence rate of 347 infections per 100 000 persons per year. This compared to an incidence of 11.5 per 100 000 persons per year in the general population (regression ratio ¼ 30.2; 95% confidence interval (CI) 17.8-50.8, Po0.00001). If nonsterile site isolates (respiratory tract) were included, the incidence rate in transplant patients was 446 per 100 000 persons per year. Serotypes 23F and 6B were most common; 100 and 69.2% of isolates were a serotype included in the pneumococcal polysaccharide and conjugate vaccines, respectively. The antimicrobial resistance rates were high, especially for trimethoprim/ sulfamethoxazole. HSCT recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.

Clinical and microbiological epidemiology of Streptococcus pneumoniae bacteremia in cancer patients

“…These results are slightly lower than those reported in France and Canada. 28,29 These discrepancies could be explained by differences in the local epidemiology, antibiotic use, vaccination programs and the years of study. Our findings support the use of the new 13-valent vaccine as preventive measure in cancer patients.…”

Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients

“…The incidence of invasive pneumococcal infection in HSCT recipients is higher than in the general population, and the incidence appears to be even higher in those patients receiving allogeneic transplantation, and also in those with chronic GVHD. [29][30][31][32] In our series, 8 out of 13 patients with pneumococcal BSI were allogeneic transplant recipients, and 6 of them had chronic GVHD. The higher rate specifically observed in allogeneic transplant recipients may be due to multiple factors, including post-transplant immunosuppression, the immunomodulatory effects of GVHD, impairment of splenic function and the absence of prior vaccination or a suboptimal vaccine response.…”

Pretransplant vaccinations in allogeneic stem cell transplantation donors and recipients: an often-missed opportunity for immunoprotection?

“…[9][10][11][12] The median onset of invasive diseases occur 1 year post HSCT, although infections occur also early after HSCT. [10][11][12][13] Vaccination before transplant in both donors and recipients has shown to influence Ab responses post transplant.…”

“…[9][10][11][12] The median onset of invasive diseases occur 1 year post HSCT, although infections occur also early after HSCT. [10][11][12][13] Vaccination before transplant in both donors and recipients has shown to influence Ab responses post transplant. 9,14,15 In the United States, there are currently two pneumococcal vaccinations available that include the PCV13 (pneumococcal conjugate vaccine) and the PPV23 (pneumococcal polysaccharide vaccine).…”