Alrugaib Trad, Alsultan Abdulrahman, Elbashir Enas, Albdah Bayan, Alharbi Musaed, Essa Mohammed F
Department of Pediatric Hematology/Oncology, King Abdullah Specialist Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia.
Pediatr Transplant. 2023 Feb;27(1):e14375. doi: 10.1111/petr.14375. Epub 2022 Aug 10.
The use of prophylactic antibiotics in the pre-engraftment period to minimize the risk of bacteremia is debatable given concerns of Clostridioides difficile (C. diff), antibiotics resistance, and disruption of gut microbiota.
We retrospectively reviewed the rate and characteristics of bacteremia and C. diff infections within the first 100 days post-HSCT in all pediatric patients who received routine antibacterial prophylaxis during HSCT from 2015 to 2018. C. diff infection was defined by the presence of three or more unformed stools in 24 h and positive stool test for C. diff or its toxins.
One hundred and thirty-five (100 allogeneic and 35 autologous) transplants in 123 patients were eligible for analysis. Median age at transplant was 7.1 (range 0.2-13.7), 67 (55%) were women, and diagnosis was malignant condition in 68 patients. Median time to neutrophil engraftment was 18 days (13-23). Cefepime or piperacillin-tazobactam prophylaxis was used in 105 (78%) and 28 (21%) of patients, respectively. Only five (3%) patients had bacteremia during the pre-engraftment period, and 13 (11%) patients developed bacteremia postengraftment. Septic shock was present in only one patient pre-engraftment and was due to gram-negative bacteria. All patients who developed bacteremia received MAC. Thirteen patients (10%) of patients fulfilled C. diff infection definition. There was no mortality related to bacterial infections among our patients.
The use of antibiotic prophylaxis was associated with low rate of bacteremia in the pre-engraftment period and a 10% risk of C. diff infections. More studies are needed to better evaluate the efficacy of antibiotic prophylaxis in HSCT patients.
鉴于艰难梭菌（C. diff）、抗生素耐药性以及肠道微生物群破坏等问题，在植入前期使用预防性抗生素以降低菌血症风险存在争议。
我们回顾性分析了2015年至2018年期间接受造血干细胞移植（HSCT）并在移植期间接受常规抗菌预防的所有儿科患者在HSCT后前100天内菌血症和C. diff感染的发生率及特征。C. diff感染定义为24小时内出现三次或更多次不成形粪便且粪便检测C. diff或其毒素呈阳性。
123例患者中的135例（100例同种异体移植和35例自体移植）符合分析条件。移植时的中位年龄为7.1岁（范围0.2 - 13.7岁），67例（55%）为女性，68例患者的诊断为恶性疾病。中性粒细胞植入的中位时间为18天（13 - 23天）。分别有105例（78%）和28例（21%）患者使用头孢吡肟或哌拉西林 - 他唑巴坦进行预防。只有5例（3%）患者在植入前期发生菌血症，13例（11%）患者在植入后发生菌血症。仅1例患者在植入前期出现感染性休克，原因是革兰氏阴性菌。所有发生菌血症的患者均接受了经验性联合抗菌治疗（MAC）。13例（10%）患者符合C. diff感染定义。我们的患者中没有与细菌感染相关的死亡病例。
预防性使用抗生素与植入前期菌血症发生率低以及10%的C. diff感染风险相关。需要更多研究来更好地评估HSCT患者预防性使用抗生素的疗效。
