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Levofloxacin prophylaxis and parenteral nutrition have a detrimental effect on intestinal microbial networks in pediatric patients undergoing HSCT
Fabbrini, M., D'Amico, F., Leardini, D., Muratore, E., Barone, M., Belotti, T., Forchielli, M. L., Zama, D., Pession, A., Prete, A., et al
Communications biology. 2023;6(1):36
Abstract
The gut microbiome (GM) has shown to influence hematopoietic stem cell transplantation (HSCT) outcome. Evidence on levofloxacin (LVX) prophylaxis usefulness before HSCT in pediatric patients is controversial and its impact on GM is poorly characterized. Post-HSCT parenteral nutrition (PN) is oftentimes the first-line nutritional support in the neutropenic phase, despite the emerging benefits of enteral nutrition (EN). In this exploratory work, we used a global-to-local networking approach to obtain a high-resolution longitudinal characterization of the GM in 30 pediatric HSCT patients receiving PN combined with LVX prophylaxis or PN alone or EN alone. By evaluating the network topology, we found that PN, especially preceded by LVX prophylaxis, resulted in a detrimental effect over the GM, with low modularity, poor cohesion, a shift in keystone species and the emergence of modules comprising several pathobionts, such as Klebsiella spp., [Ruminococcus] gnavus, Flavonifractor plautii and Enterococcus faecium. Our pilot findings on LVX prophylaxis and PN-related disruption of GM networks should be considered in patient management, to possibly facilitate prompt recovery/maintenance of a healthy and well-wired GM. However, the impact of LVX prophylaxis and nutritional support on short- to long-term post-HSCT clinical outcomes has yet to be elucidated.
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Association of zinc deficiency with infectious complications in pediatric hematopoietic stem cell transplantation patients
Suwanphoerung, W., Klinmalai, C., Rattanasiri, S., Pakakasama, S., Anurathapan, U., Hongeng, S., Chongviriyaphan, N., Apiwattanakul, N.
PloS one. 2022;17(12):e0279439
Abstract
BACKGROUND Zinc plays essential roles in immune function and epithelial integrity. Patients undergoing hematopoietic stem cell transplantation (HSCT) often have low plasma zinc levels because of poor intake and diarrhea. We hypothesized that patients with zinc deficiency before HSCT had worse infectious complications after HSCT compared with patients with normal zinc levels. Citrulline, a marker of intestinal integrity, was also hypothesized to be lower in patients with zinc deficiency. PATIENTS AND METHODS Thirty patients undergoing HSCT at Ramathibodi Hospital during March 2020-September 2021 were enrolled. Blood samples for plasma zinc and citrulline were collected during the HSCT period. The 14- and 90-day outcomes after HSCT were prospectively recorded. RESULTS Twelve of 30 (40%) patients had zinc deficiency before HSCT. Zinc-deficient patients were younger (median (interquartile range): 6 (8.8) vs 13 (5.8) years old; p = 0.017). Zinc levels tended to increase after admission in both groups. Patients with zinc deficiency had lower citrulline levels than those with normal zinc levels. Citrulline levels decreased in both groups after stem cell infusion, and the level was not significantly different between the two groups. Zinc-deficient patients had a higher rate of bacterial infection within 90 days after HSCT than those with normal zinc levels (6 in 12 patients (50.0%) vs 1 in 18 patients (5.6%); odds ratio [OR]: 17.0; 95% confidence interval [CI]: 1.68-171.70; p = 0.016). This remained significant after adjustments for age (adjusted OR: 12.31; 95% CI: 1.084-139.92; p = 0.043). CONCLUSION The prevalence of zinc deficiency in pediatric patients undergoing HSCT was high. Zinc-deficient patients had lower citrulline levels and higher incidence of bacterial infection after HSCT. However, citrulline level was not different between patients with and without bacterial infections. It is worth to investigate whether zinc supplementation before HSCT can reduce bacterial infection after HSCT.
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3.
The nutrition risk index is associated with bacteraemia within 30 days after autologous stem cell transplantation in patients with multiple myeloma
Garzon Herazo, J. R., Mauricio Munoz Velandia, O., Solano, J. C., Molina Pimienta, L., Figueroa Lemus, W. J.
Transplant infectious disease : an official journal of the Transplantation Society. 2020;:e13302
Abstract
OBJECTIVES To assess whether the nutrition risk index (NRI) is associated with the risk of bacteraemia within the first days after autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). MATERIALS AND METHODS Retrospective cohort study of adult patients with MM taken to ASCT at the Hospital Universitario San Ignacio (Bogota, Colombia) between 2005 and 2019. The outcome of interest was the incidence of bacteraemia at 30 days. Multivariate analysis was used to identify if the NRI was associated with bacteraemia, controlling by different confounding variables. RESULTS 124 patients with a median age of 58.5 years, (IQR 54 - 64) were included. 47.1% were in stage ISS III. 36.0% had moderate or severe malnourishment (NRI <97.5). 11.2% presented bacteraemia in the first 30 days after transplantation. In the univariate analysis, the NRI <97.5 was associated with bacteraemia (OR 1.88; 95% CI 1.30 - 2.72, p = 0.001), however this association was not significant in the multivariate analysis, unlike the presence mucositis (OR 11.59; 95% CI 1.9-68.3, <0.01), one or more previous lines of therapy (OR 12.0; 95% CI 2.1 - 67.4; p <0.01) and duration of aplasia (OR 1.70; 95% CI 1.2-2.4, p <0.01) CONCLUSIONS Patients with moderate or severe malnourishment have a higher incidence of bacteraemia in the 30 days post ASCT in patients with MM. Additional risk factors associated with bacteraemia include the presence of mucositis, one or more previous lines of therapy, and the duration of aplasia.
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Revisiting Infectious Complications Following Total Parenteral Nutrition Use During Hematopoietic Stem Cell Transplantation
Rubin, H., Mehta, J., Fong, J. L., Greenberg, D., GrusChak, S., Trifilio, S.
Journal of the advanced practitioner in oncology. 2020;11(7):675-682
Abstract
BACKGROUND Total parenteral nutrition (TPN) is frequently used to manage caloric needs during hematopoietic stem cell transplantation (HSCT). Previous studies in transplant patients who received TPN have reported widely discordant results with regard to infection and mortality, and risk factors for TPN-related infection remain unclear. METHOD We conducted a retrospective study of all HSCT recipients treated with TPN between 2005 to 2014 at Northwestern Memorial Hospital to determine the incidence and epidemiology of infections. Electronic records were used to identify patients treated with TPN for at least 2 days who developed infection. RESULTS Among 198 patients treated with TPN, 30% developed documented infection. Total parenteral nutrition treatment duration (13 vs. 7 days; p < .0001) and the timing of TPN initiation (> day 9 post HSCT; p < .0001) were significantly higher in patients who received TPN and developed infection. Receipt of an allogeneic transplant was associated with increased risk for infection (p < .0138), and day 60 mortality was significantly higher in TPN-treated patients with infection (p < .0001). CONCLUSION Stem cell recipients who receive TPN, especially from an allogeneic donor, have high rates of infection and mortality. Minimizing TPN exposure may reduce the chance for infection.
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5.
Enteral nutrition protects children undergoing allogeneic hematopoietic stem cell transplantation from blood stream infections
Zama, D., Muratore, E., Biagi, E., Forchielli, M. L., Rondelli, R., Candela, M., Prete, A., Pession, A., Masetti, R.
Nutrition journal. 2020;19(1):29
Abstract
Enteral Nutrition (EN) is recommended as first line nutritional support for patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT), but only few studies exist in the literature which compare EN to Parenteral Nutrition (PN) in the paediatric population.Forty-two consecutive paediatric patients undergoing allo-HSCT at our referral centre between January 2016 and July 2019 were evaluated. Post-transplant and nutritional outcomes of patients receiving EN for more than 7 days (EN group, n = 14) were compared with those of patients receiving EN for fewer than 7 days or receiving only PN (PN group, n = 28). In the EN group, a reduced incidence of Blood Stream Infections (BSI) was observed (p = 0.02) (n = 2 vs. n = 15; 14.3% vs. 53.6%). The type of nutritional support was also the only variable independently associated with BSI in the multivariate analysis (p = 0.03). Platelet engraftment was shorter in the PN group than in the EN group for a threshold of > 20*10(9)/L (p = 0.04) (23.1 vs 35.7 days), but this correlation was not confirmed with a threshold of > 50*10(9)/L. The Body Mass Index (BMI) and the BMI Z-score were no different in the two groups from admission to discharge.Our results highlight that EN is a feasible and nutritionally adequate method of nutritional support for children undergoing allo-HSCT in line with the present literature. Future functional studies are needed to better address the hypothesis that greater intestinal eubyosis maintained with EN may explain the observed reduction in BSI.
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6.
Nutritional risk index as a risk factor for breakthrough candidemia in allogeneic hematopoietic stem cell transplantation
Kaito, S., Sekiya, N., Najima, Y., Suzuki, T., Wada, A., Adachi, H., Konuma, R., Kishida, Y., Nagata, A., Konishi, T., et al
Bone marrow transplantation. 2019