Bloodstream bacterial infections in thalassemic pediatric and adolescent patients after hematopoietic stem cell transplantation

Abstract Changes in the transplantation procedure and the implementation of effective supportive care strategies have decreased the incidence of infectious complications early after conditioning therapy for allogeneic hematopoietic stem cell transplantation (HCT) and have extended the duration of risks later. Therefore, the types of infections that cause significant morbidity and the timing of risks have changed. These late infections are caused by all types of organisms, bacterial, viral, and fungal, but risks are predictable and surmountable with the use of tailored prevention strategies. Specifically, recent studies document prolonged risks for bacterial infections in the setting of GVHD, especially those caused by encapsulated organisms and those secondary to impaired Ab responses. Both prophylaxis and vaccination strategies can be used as a means to prevent infections, which typically manifest in the respiratory tract. Multiple viruses cause infection later after HCT, including several herpesviruses (eg, CMV and varicella zoster virus) and other respiratory viruses such as influenza and adenovirus. These infections can cause severe disease with diagnostic challenges, but prevention strategies using enhanced monitoring and/or prophylaxis may be effective. Finally, fungi also cause disease late after HCT, especially filamentous fungi (eg, Aspergillus species and Mucormycoses) and Pneumocystis jiroveci; prophylactic strategies may be used successfully to prevent invasive infection. Late infections and methods to prevent them are reviewed herein.

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Prospective study on Prophylactic Micafungin sodium against Invasive Fungal Disease during Neutropenia in Pediatric & Adolescent Patients undergoing Autologous Hematopoietic Stem Cell Transplantation

10.22541/au.162688791.15206441/v1 ◽

2021 ◽

Author(s):

Bo Kyung Kim ◽

Jung Yoon Choi ◽

Kyung Taek Hong ◽

Hong Yul An ◽

Hee Young Shin ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Treatment Success ◽

Open Label ◽

Hematopoietic Stem ◽

Adolescent Patients ◽

Autologous Hsct

Background Invasive fungal diseases (IFDs) increase the mortality rate of patients with neutropenia who receive chemotherapy or have previously undergone hematopoietic stem cell transplantation (HSCT). Micafungin is a broad-spectrum echinocandin, with minimal toxicity and low drug interactions. We therefore investigated the efficacy and safety of prophylactic micafungin in pediatric and adolescent patients who underwent autologous HSCT. Methods This was a phase II, prospective, single-center, open-label, and single-arm study. From November 2011 to February 2017, 125 patients were screened from Seoul National University Children’s Hospital, Korea, and 112 were enrolled. Micafungin was administered intravenously at a dose of 1 mg/kg/day (maximum 50 mg/day) from day 8 of autologous HSCT until neutrophil engraftment. Treatment success was defined as the absence of proven, probable, or possible IFD up to 4 weeks after therapy. Results The study protocol was achieved without premature interruption in 110 patients (98.2%). The reasons interrupting micafungin treatment included early death (n=1) and patient refusal (n=1). Treatment success was achieved in 109 patients (99.1%). Only one patient was diagnosed with probable IFD. No patients were diagnosed with possible or proven IFD. In the full analysis set, 21 patients (18.8%) experienced 22 adverse events (AEs); however, all AEs were classified as “unlikely” related to micafungin. No patient experienced grade IV AEs nor discontinued treatment and none of the deaths were related to micafungin. Conclusions Our study demonstrated that micafungin is a safe and effective option for antifungal prophylaxis in pediatric patients who underwent autologous HSCT, with promising efficacy without significant AEs.

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Gynecologic Care for Pediatric and Adolescent Patients Undergoing Hematopoietic Stem Cell Transplantation

Journal of Pediatric and Adolescent Gynecology ◽

10.1016/j.jpag.2020.12.007 ◽

2020 ◽

Author(s):

Katherine E. Debiec ◽

Nicole Todd

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Hematopoietic Stem ◽

Adolescent Patients

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ANTIBACTERIAL RESISTANCE IN PATIENTS WITH HEMATOPOIETIC STEM CELL TRANSPLANTATION

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2017.002 ◽

2016 ◽

Vol 9 (1) ◽

pp. e2017002 ◽

Cited By ~ 2

Author(s):

Murat Akova

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Bacterial Infections ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Antibacterial Resistance ◽

Hematopoietic Stem

Recipients of hematopoietic stem cell transplantation (HSCT) are at substantial risk of bacterial, fungal, viral, and parasitic infections depending on the time elapsed since transplantation, presence of graft-versus-host disease (GVHD), and the degree of immunosuppression. Infectious complications in HSCT recipients are associated with high morbidity and mortality. Bacterial infections constitute the major cause of infectious complications, especially in the early post-transplant period. The emergence of antibacterial resistance complicates the management of bacterial infections in this patient group. Multidrug-resistant bacterial infections in this group of patients have attracted considerable interest and may lead significant morbidity and mortality. Empirical antibacterial therapy in patients with HSCT and febrile neutropenia has a critical role in survival and should be based on local epidemiology. This review attempts to provide an overview of resistant bacterial infections in HSCT recipients. Keywords: Hematopoietic stem cell transplantation, antibacterial resistance, resistant bacterial infection.

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Evaluation of the Bacterial Etiologies of Infections in Patients Undergoing Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v124.21.5850.5850 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5850-5850

Author(s):

Lokman Hizmali ◽

Umit Tapan ◽

Haluk Eraksoy

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Bacterial Infection ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Bacterial Infections ◽

Bacterial Isolates ◽

Gram Positive ◽

Hematopoietic Stem

Abstract Objectives: Bacterial infections increase morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). The characteristics of the bacteria causing infections in these patients undergo dynamic changes both globally and locally during the transplantation process. The etiology of bacterial isolates and analysis of changes in the antibiotic sensitivities are crucial for the selection of appropriate prophylactic and empiric therapies. In this study we aimed to evaluate the first episode of bacterial infection in patients undergoing allogeneic or autologous hematopoietic stem cell transplantation and to identify bacterial isolates and the resistance profile of causative bacteria. Materials and Methods: In this retrospective study, the charts of 195 patients who underwent allogeneic or autologous hematopoietic stem cell transplantation between January 2010 and December 2013 were reviewed. Ninety-six patients who had microbiologic evidence of bacterial infection were included in the study. The culture results from the first infectious episode during the transplantation process were evaluated. Patients were grouped according to the type of transplantation, and categorized according to the transplantation process, presence of neutropenia and infection status. Microbiological examination of samples obtained for culture and sensitivity analysis were performed according to standards of the National Committee for Clinical Laboratory Standards Institute (CLSI). Results: Gram-negative and Gram-positive bacteria were identified in 54.2% and 44.8% of the infectious episodes, respectively. Poly-microbial etiology was identified in only 1.0% of these episodes. E. coli and coagulase-negative staphylococci (CoNS) were the most frequently isolated pathogens. In the early stage infections, Gram-positive organisms were more frequently isolated (72.1%) (p=0.042) and a significantly larger number of patients had undergone autologous stem cell transplantation (p<0.001). This situation was explained by the absence of antimicrobial prophylaxis in the autologous group, intensive induction chemotherapy, presence of catheter and mucosal damage. The frequency of extended-spectrum β-lactamase (ESBL) was found to be very high in the allogeneic group compared to the autologous group (36.4% vs. 13.3%). All of the staphylococcal isolates in the allogeneic group were noted to be methicillin resistant. Conclusions: Treatment and prophylaxis have become increasingly more challenging with the infections caused by resistant pathogens. It is imperative to carefully monitor causative agents of bacterial infections and to plan prophylactic and empiric treatments according to characteristics of the individual patients. Disclosures No relevant conflicts of interest to declare.

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