Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan.
PLoS One. 2024 Aug 7;19(8):e0308395. doi: 10.1371/journal.pone.0308395. eCollection 2024.
Allogeneic hematopoietic cell transplantation (HCT) is a crucial treatment for various diseases, including hematological malignancies, solid tumors, and genetic disorders. Despite its curative potential, HCT is associated with severe complications, notably infections, graft-versus-host disease, and organ damage. Infections, particularly bloodstream infections (BSIs), pose a significant threat in the initial weeks post-HCT, necessitating effective management strategies. This retrospective study aimed to clarify the incidence, pathogens, and risk factors associated with BSI within the first 30 days after allogeneic HCT in children/adolescents and young adults (AYAs). The study included 115 patients aged <31 years who underwent 121 allogeneic HCTs at the Department of Pediatrics, Nagoya University Hospital between January 1, 2018, and March 31, 2022. Data encompassed demographic characteristics, HCT details, and BSI information. Overall, 27 of 121 patients developed BSI with the cumulative incidence of 23.5% (95% confidence intervals [CI]: 17.0%-30.6%) at 30 days after HCT. The median onset time of BSI was 7 (range, 4-26 days) after HCT. Gram-positive bacteria accounted for 89% of pathogens isolated from blood cultures, with Streptococcus mitis/oralis being the most common. In multivariable analysis, tandem HCT (subdistribution hazard ratio [SHR]: 5.67, 95% CI: 2.74-11.7, p < 0.001) and peripherally inserted central catheters (SHR: 2.96, 95% CI: 1.34-6.55, p = 0.007) were identified as independent risk factors for BSI. In patients receiving tandem HCT, the pathogens isolated from blood cultures were all gram-positive bacteria, with Streptococcus mitis/oralis accounting for up to 67% of the isolated pathogens. Tandem HCT and PICCs were identified as independent risk factors for BSI after allogeneic HCT in children/AYAs. The pathogens were commonly gram-positive, and Streptococcus mitis/oralis is important in patients who received tandem HCT. These data can provide valuable information for future studies to consider effective interventions to reduce the risk of BSI in high-risk patients.
异基因造血细胞移植（HCT）是治疗各种疾病的重要手段，包括血液系统恶性肿瘤、实体瘤和遗传疾病。尽管 HCT 具有潜在的治愈效果，但它也会引起严重的并发症，特别是感染、移植物抗宿主病和器官损伤。感染，特别是血流感染（BSI），是 HCT 后最初几周的重大威胁，需要采取有效的管理策略。这项回顾性研究旨在明确儿童/青少年和年轻成人（AYA）接受异基因 HCT 后 30 天内 BSI 的发生率、病原体和相关风险因素。该研究纳入了 2018 年 1 月 1 日至 2022 年 3 月 31 日期间在名古屋大学医院儿科接受 121 例异基因 HCT 的 115 名年龄<31 岁的患者。研究数据包括人口统计学特征、HCT 细节和 BSI 信息。总体而言，121 例患者中有 27 例发生 BSI，HCT 后 30 天内的累积发生率为 23.5%（95%置信区间 [CI]：17.0%-30.6%）。BSI 的中位发病时间为 HCT 后 7 天（范围：4-26 天）。从血培养中分离出的病原体中，革兰阳性菌占 89%，其中最常见的是缓症链球菌。多变量分析显示，串联 HCT（亚分布危险比 [SHR]：5.67，95%CI：2.74-11.7，p<0.001）和外周插入中心导管（SHR：2.96，95%CI：1.34-6.55，p=0.007）是 BSI 的独立危险因素。在接受串联 HCT 的患者中，血培养分离出的病原体均为革兰阳性菌，缓症链球菌占分离病原体的 67%。串联 HCT 和 PICCs 是儿童/AYA 接受异基因 HCT 后 BSI 的独立危险因素。病原体通常为革兰阳性菌，缓症链球菌在接受串联 HCT 的患者中很重要。这些数据可为未来的研究提供有价值的信息，以考虑采取有效的干预措施来降低高危患者发生 BSI 的风险。
