Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.
Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland.
Pediatr Allergy Immunol. 2020 Jul;31(5):537-543. doi: 10.1111/pai.13239. Epub 2020 Apr 6.
The aim of this nationwide study was to evaluate the characteristics of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in pediatric patients with PID after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
In total, 114 HSCT recipients were enrolled into the study. At least one infectious complication (IC) was diagnosed in 60 (52.6%) patients aged 0.1-17.7 years, that is, 59.5% with SCID and 49.4% with non-SCID.
Among 60 HSCT recipients diagnosed with at least one IC, 188 episodes of infectious complications (EIC) were recorded, that is, 46.8% of BI, 41.5% of VI, and 11.7% of proven/probable IFD. According to PID and HSCT donor type, the incidence of EIC was comparable (P = .679). The localization of infections differed significantly due to PID type (P = .002). After each HSCT donor type, the most common site of infection was GI. Overall, BI caused by Gram-positive strains (59.1%) were prevalent, especially Staphylococcaceae. The multidrug-resistant (MDR) pathogens were diagnosed in 52.3%, especially ESBL + Enterobacteriaceae. The profile of VI was comparable for SCID and non-SCID patients (P = .839). The incidence of IFD was comparable for each PID and HSCT donor type. Survival after infection was 91.5% and was comparable for PID and HSCT donor type.
The rate of patients diagnosed with IC among pediatric PID-HSCT recipients did not depend on PID type, but rather on HSCT donor type. The localization of IC depended on PID and HSCT donor type. Within bacterial infections, predominated Gram-positive strains and the MDR pathogens were responsible for more than half of EIC.
本全国性研究旨在评估异基因造血干细胞移植（allo-HSCT）后小儿 PID 患者的细菌感染（BI）、侵袭性真菌病（IFD）和病毒感染（VI）的特征。
共有 114 例 HSCT 受者入组本研究。0.1-17.7 岁的患者中至少有 1 例感染并发症（IC）诊断，即 59.5%的 SCID 和 49.4%的非 SCID。
在诊断为至少 1 例 IC 的 60 例 HSCT 受者中，共记录了 188 例感染并发症（EIC），即 46.8%的 BI、41.5%的 VI 和 11.7%的确诊/疑似 IFD。根据 PID 和 HSCT 供体类型，EIC 的发生率相当（P=0.679）。由于 PID 类型，感染的定位有显著差异（P=0.002）。在每种 HSCT 供体类型之后，最常见的感染部位是 GI。总体而言，BI 由革兰氏阳性菌（59.1%）引起，特别是葡萄球菌科。诊断出耐多药（MDR）病原体的比例为 52.3%，特别是 ESBL+肠杆菌科。SCID 和非 SCID 患者的 VI 谱相当（P=0.839）。每种 PID 和 HSCT 供体类型的 IFD 发生率相当。感染后的生存率为 91.5%，PID 和 HSCT 供体类型相当。
小儿 PID-HSCT 受者中诊断为 IC 的患者比例与 PID 类型无关，而与 HSCT 供体类型有关。IC 的定位取决于 PID 和 HSCT 供体类型。在细菌感染中，革兰氏阳性菌占主导地位，MDR 病原体占 EIC 的一半以上。
