Department of Pediatrics, Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil.
Division of Epidemiology and Infection Control, Department of Pediatrics, Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil.
Transpl Infect Dis. 2021 Jun;23(3):e13532. doi: 10.1111/tid.13532. Epub 2020 Dec 12.
Pediatric hematopoietic stem cell transplantation (HSCT) recipients represent a vulnerable population with regard to health care-associated infections (HAI) with a differentiated profile of etiologic agents. There are few reports in the literature regarding HAI in the pediatric population submitted to HSCT.
This is a retrospective study conducted in a pediatric HSCT unit in Curitiba, Brazil between February 2013 and December 2017 that evaluated 109 pediatric patients. The variables analyzed were: age, gender, baseline disease, type of transplantation, infection topography, etiologic agent, time of HAI occurrence, antimicrobial prophylaxis, period of neutropenia, length of stay, and outcomes RESULTS: Of 113 HSCT procedures, 91 (83.5%) were allogenic and 18 were autologous (16.5%). The mean age of the patients was 7.9 years, with a median of 8.1 years (4.0 months-17.3 years); 71 (65.1%) were male; 55 (50.5%) presented with an oncologic diagnosis, 32 (29.4%) with a hematological diagnosis, 17 (15.6%) with immunodeficiencies, and 5 (4.6%) with other causes. During hospitalization after HSCT, 86 episodes of HAI were detected in 66 patients, with an infection density of 16.5 infections/1000 patient days, 86% of which occurred after allogeneic transplants, appearing, on average, 15.3 days after transplantation. The main topographies were bloodstream infection (BSI), with 24 (27.9%) cases, and central line-associated bloodstream infection (CLABSI), with 11 (12.8%). Gram-positive bacteria predominated in cultures and HAI was more frequent in patients diagnosed with immunodeficiencies and other non-oncologic and non-hematologic conditions. Among the Gram-positive bacteria, Staphylococcus epidermidis was the main agent identified (77.7%), possibly because of colonization. However, Gram-negative bacteria, with a resistance profile, comprised 40% of the cases of bacterial infections, most of them represented by Klebsiella pneumoniae (66.6%). Of the 66 patients who presented HAI, 59 patients (89.4%) were discharged, and 7 (10.6%) died.
The main topographies were CLABSI and BSI. Patients with immunodeficiencies presented a higher risk for HAI Staphylococcus epidermidis was the main agent identified. However, Klebsiella pneumoniae posed a higher risk for Pediatric Intensive Care Unit admission and death.
儿科造血干细胞移植（HSCT）受者是医疗相关感染（HAI）的脆弱人群，其病原体具有不同的特征。关于接受 HSCT 的儿科人群中的 HAI，文献中报道较少。
这是一项在巴西库里蒂巴的儿科 HSCT 病房进行的回顾性研究，共纳入 2013 年 2 月至 2017 年 12 月期间的 109 名儿科患者。分析的变量包括：年龄、性别、基础疾病、移植类型、感染部位、病原体、HAI 发生时间、抗菌预防、中性粒细胞减少时间、住院时间和结果。
在 113 例 HSCT 手术中，91 例（83.5%）为异基因移植，18 例为自体移植（16.5%）。患者的平均年龄为 7.9 岁，中位数为 8.1 岁（4.0 个月-17.3 岁）；71 例（65.1%）为男性；55 例（50.5%）有肿瘤诊断，32 例（29.4%）有血液学诊断，17 例（15.6%）有免疫缺陷，5 例（4.6%）有其他原因。在 HSCT 后住院期间，在 66 名患者中发现了 86 例 HAI，感染密度为 16.5 例/1000 患者天，其中 86%发生在异基因移植后，平均在移植后 15.3 天出现。主要感染部位为血流感染（BSI），24 例（27.9%），中心静脉相关血流感染（CLABSI），11 例（12.8%）。培养物中以革兰氏阳性菌为主，HAI 更常见于免疫缺陷和其他非肿瘤和非血液学疾病的患者。在革兰氏阳性菌中，表皮葡萄球菌是主要病原体（77.7%），可能是由于定植。然而，革兰氏阴性菌，具有耐药谱，占细菌感染的 40%，其中大多数为肺炎克雷伯菌（66.6%）。在出现 HAI 的 66 名患者中，59 名（89.4%）患者出院，7 名（10.6%）死亡。
主要感染部位为 CLABSI 和 BSI。免疫缺陷患者发生 HAI 的风险较高，表皮葡萄球菌是主要病原体。然而，肺炎克雷伯菌更容易导致儿科重症监护病房入住和死亡。
