Srinivasan A, McLaughlin L, Wang C, Srivastava D K, Shook D R, Leung W, Hayden R T
Departments of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Transpl Infect Dis. 2014 Feb;16(1):90-7. doi: 10.1111/tid.12165. Epub 2013 Nov 21.
Advances in autologous hematopoietic stem cell transplantation (HSCT) over the past 20 years may have had an impact on the morbidity and mortality associated with infections post transplant.
We sought to retrospectively analyze the epidemiology of the first episode of bacterial, fungal, viral, or parasitic infections 0-30 days post transplant in a cohort of 320 children and adolescents who underwent autologous HSCT in a single institution, between 1990 and 2009 for solid tumors or lymphoma, and in 65 children transplanted for acute leukemia during the same period.
Infections occurred in 66 (21%) patients with solid tumors or lymphoma. Bacterial infections occurred in 33 (10%) including bacteremia in 23 (7%), and viral infections in 34 (11%) patients. Gram-positive bacterial infections were more prevalent than gram-negative bacterial infections (P = 0.03). Infections caused by fungal or parasitic pathogens were uncommon. The decade when transplant was performed (1990-1999 vs. 2000-2009) had no impact on the incidence of bacterial (P = 0.41) or viral (P = 0.47) infection. Between 1990 and 1999, a total of 60 (92%) children were transplanted for leukemia, and 5 (8%) in the 2000-2009 period (P < 0.0001). Infections occurred in 32 (49%) patients. Bacterial (P = 0.004), candidal (P = 0.003), and herpes simplex viral (P = 0.03) infections were more common in patients transplanted for leukemia. In patients transplanted for leukemia, 3 deaths occurred attributed to infection, all before 2000.
Changes in epidemiology of infection are likely a result of decline in autologous transplantation for childhood leukemia in the recent era. Autologous transplantation for solid tumors or lymphoma was not associated with mortality from early infections at our institution.
过去20年中自体造血干细胞移植（HSCT）的进展可能对移植后感染相关的发病率和死亡率产生了影响。
我们试图回顾性分析1990年至2009年间在单一机构接受自体HSCT治疗实体瘤或淋巴瘤的320名儿童和青少年，以及同期65名接受急性白血病移植的儿童在移植后0至30天内首次发生细菌、真菌、病毒或寄生虫感染的流行病学情况。
实体瘤或淋巴瘤患者中有66例（21%）发生感染。细菌感染33例（10%），其中菌血症23例（7%），病毒感染34例（11%）。革兰氏阳性菌感染比革兰氏阴性菌感染更常见（P = 0.03）。真菌或寄生虫病原体引起的感染不常见。进行移植的十年期（1990 - 1999年与2000 - 2009年）对细菌（P = 0.41）或病毒（P = 0.47）感染的发生率没有影响。1990年至1999年期间，共有60名（92%）儿童接受白血病移植，2000 - 2009年期间为5名（8%）（P < 0.0001）。白血病移植患者中有32例（49%）发生感染。细菌（P = 0.004）、念珠菌（P = 0.003）和单纯疱疹病毒（P = 0.03）感染在白血病移植患者中更常见。在白血病移植患者中，有3例死亡归因于感染，均发生在2000年之前。
感染流行病学的变化可能是近期儿童白血病自体移植减少的结果。在我们机构，实体瘤或淋巴瘤的自体移植与早期感染导致的死亡率无关。
