Zając-Spychała O, Wachowiak J, Pieczonka A, Siewiera K, Frączkiewicz J, Kałwak K, Gorczyńska E, Chybicka A, Czyżewski K, Jachna-Sawicka K, Wysocki M, Klepacka J, Goździk J, Zaucha-Prażmo A, Kowalczyk J R, Styczyński J
Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.
Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland.
Transpl Infect Dis. 2016 Oct;18(5):690-698. doi: 10.1111/tid.12581. Epub 2016 Sep 23.
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.
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.
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.
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.
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.
感染性并发症是造血干细胞移植（HSCT）失败的重要原因，尤其是异基因HSCT（allo-HSCT），这是由于免疫重建延迟和移植物抗宿主病（GVHD）的发生。确定HSCT患者发生细菌感染（BI）的相关因素将为该组患者提供更有效的经验性抗菌治疗。
本研究旨在评估2012 - 2013年波兰儿科造血干细胞移植组5个中心HSCT后患者BI的流行病学及特征。
在308例HSCT受者中，我们回顾性分析了113例（36.7%）年龄在0.02 - 22岁（中位年龄：7岁）儿童的273次BI发作，其中92次发生在allo-HSCT后，22次发生在自体HSCT（auto-HSCT）后。我们通过计算细菌感染指数（IBI）来评估不同类型HSCT中BI的发生率，IBI为至少发生1次BI的患者数与分析期间接受该类型HSCT的所有患者数之比。我们评估了BI的特征，特别关注多重耐药菌，以及基础疾病和移植物抗宿主病对BI发作的影响。
在研究组中，共诊断出273次BI发作，其中allo-HSCT后237次，auto-HSCT后36次。在诊断为至少1次BI的allo-HSCT受者中，IBI为0.4（同胞全相合供者-HSCT为0.3；供者全相合-HSCT为0.4；不相合非血缘供者[MMUD]-HSCT为0.8；P = 0.027），auto-HSCT后每例移植患者为0.3。在因骨髓或淋巴细胞增殖性疾病及骨髓衰竭接受allo-HSCT的患者中，感染的主要原因是肠杆菌科细菌，而在原发性免疫缺陷组中革兰氏阳性菌占主导。在所有auto-HSCT后的患者中，BI的主要病原体是肠杆菌科细菌（P = 0.011）。不同类型HSCT至不同病原体引起感染的时间差异无统计学意义。
BI的风险不取决于基础疾病，而仅取决于HSCT供者类型，且在MMUD-HSCT术后最高。BI的特征取决于基础疾病和HSCT供者类型，但不取决于急性GVHD的发生。在骨髓和淋巴细胞增殖性疾病患者中革兰氏阴性菌占主导，而在原发性免疫缺陷患者中革兰氏阳性菌占主导。
