1.
Multidrug-resistant bacterial infections in children undergoing hematopoietic stem cell transplantation over a 6-year period: analysis of the of Polish Pediatric Group for Hematopoietic Stem Cell Transplantation
Zajac-Spychala, O., Wachowiak, J., Fraczkiewicz, J., Salamonowicz, M., Kalwak, K., Gorczynska, E., Chybicka, A., Czyzewski, K., Dziedzic, M., Wysocki, M., et al
Journal of applied microbiology. 2019
Abstract
AIMS: Multidrug-resistant (MDR) bacteria are an emerging cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). The aim of the study was to analyze the incidence, clinical characteristics and survival from bacterial infections caused by MDR pathogens in pediatric HSCT recipients. METHODS AND RESULTS Between 2012 and 2017, among 971 transplanted patients, bacterial infections were found in 416 children. Overall, there were 883 bacterial episodes, including 85.8% after allo-HSCT and 14.2% after auto-HSCT. MDR strains were responsible for half of the total number of bacterial episodes. Over 50% of MDR pathogens were Enterobacteriaceae causing mainly gut infections or urinary tract infections. CONCLUSIONS Regarding HSCT type, we did not find differences in the profile of MDR bacterial infections between allo- and auto-HSCT recipients. However, survival in MDR and non-MDR infections was comparable. SIGNIFICANCE AND IMPACT OF STUDY The large sample size enables unique analysis and makes our data more applicable to other pediatric HSCT centers. In case of the absence of local epidemiological data, presented clinical characteristic of MDR-caused infections may be used to optimize the prophylactic strategies, early identification of infectious complications of MDR etiology, and thus promptly initiate adequate antibiotic therapy and further improve patients' outcome.
2.
Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation
Salamonowicz, M., Ociepa, T., Fraczkiewicz, J., Szmydki-Baran, A., Matysiak, M., Czyzewski, K., Wysocki, M., Galazka, P., Zalas-Wiecek, P., Irga-Jaworska, N., et al
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018
Abstract
Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.
3.
Bacterial infections in pediatric hematopoietic stem cell transplantation recipients: incidence, epidemiology, and spectrum of pathogens: report of the Polish Pediatric Group for Hematopoietic Stem Cell Transplantation
Zajac-Spychala, O., Wachowiak, J., Pieczonka, A., Siewiera, K., Fraczkiewicz, J., Kalwak, K., Gorczynska, E., Chybicka, A., Czyzewski, K., Jachna-Sawicka, K., et al
Transplant Infectious Disease. 2016;18(5):690-698
Abstract
BACKGROUND Infectious complications are a significant cause of hematopoietic stem cell transplantation (HSCT) failure, especially allogeneic HSCT (allo-HSCT) because of delayed immune reconstitution and graft-versus-host disease (GVHD) occurrence. Identifying the factors responsible for bacterial infections (BI) in patients undergoing HSCT will provide much more effective empirical antimicrobial treatment in this group of patients. OBJECTIVE The aim of this study was to evaluate the epidemiology and profile of BI in patients after HSCT in 5 centers of the Polish Pediatric Group for Hematopoietic Stem Cell Transplantation in 2012-2013. PATIENTS AND METHODS In 308 HSCT recipients, we retrospectively analyzed 273 episodes of BI in 113 (36.7%) children aged 0.02-22 years (median age: 7 years), 92 after allo-HSCT and 22 after autologous HSCT (auto-HSCT). We assessed incidence of BI in different HSCT types by calculating the Index of Bacterial Infection (IBI) as a ratio of patients with at least 1 BI to all patients who underwent this type of HSCT in the analyzed period. We assessed the profile of BI with particular emphasis on multidrug-resistant organisms, and impact of underlying disease and of graft-versus-host disease on BI episodes. RESULTS In the studied group, 273 episodes of BI were diagnosed, including 237 episodes after allo-HSCT and 36 after auto-HSCT. Among allo-HSCT recipients diagnosed with at least 1 BI, the IBI was 0.4 (matched sibling donor-HSCT 0.3; matched donor-HSCT 0.4; mismatched unrelated donor [MMUD]-HSCT 0.8; P = 0.027) and after auto-HSCT 0.3 per 1 transplanted patient. In patient after allo-HSCT because of myelo- or lymphoproliferative diseases and bone marrow failures, the major cause of infections was Enterobacteriaceae, while gram-positive bacteria predominated in the group with primary immunodeficiencies. In all patients after auto-HSCT, the dominant pathogen of BI were Enterobacteriaceae (P = 0.011). Time from each type of HSCT to infection caused by different pathogens did not differ significantly. CONCLUSIONS The risk of BI does not depend on the underlying disease, but only on HSCT donor type and is the highest after MMUD-HSCT procedure. The profile of BI depends on the underlying disease and HSCT donor type, but does not depend on the occurrence of acute GVHD. Gram-negative bacteria predominated in patients with myelo- and lymphoproliferative diseases, while in patients with primary immunodeficiencies gram-positive strains were predominant. Copyright © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.