Richert-Przygońska Monika, Czyżewski Krzysztof, Zalas-Więcek Patrycja, Gryniewicz-Kwiatkowska Olga, Gietka Agnieszka, Małas Zofia, Semczuk Katarzyna, Chełmecka Liliana, Żak Iwona, Salamonowicz-Bodzioch Małgorzata, Frączkiewicz Jowita, Zając-Spychała Olga, Bień Ewa, Irga-Jaworska Ninela, Płonowski Marcin, Wawryków Paweł, Bartnik Magdalena, Pierlejewski Filip, Gamrot Zuzanna, Badowska Wanda, Stolpa Weronika, Musiał Jakub, Szmydki-Baran Anna, Hutnik Łukasz, Tomaszewska Renata, Urbanek-Dądela Agnieszka, Zaucha-Prażmo Agnieszka, Goździk Jolanta, Styczyński Jan
Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, 85-094 Bydgoszcz, Poland.
Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, 85-094 Bydgoszcz, Poland.
J Clin Med. 2025 May 26;14(11):3714. doi: 10.3390/jcm14113714.
: (PSA) infections are associated with a high recurrence rate and high mortality in immuno-compromised patients. There are limited studies regarding pediatric hematopoietic cell transplantation recipients. : The nationwide multicenter study was conducted to analyze the epidemiology of PSA infections in children treated with chemotherapy (PHO, pediatric hematology and oncology) or undergoing hematopoietic allogeneic or autologous cell transplantation (HCT) in the period 2014-2023. : We retrospectively analyzed the clinical and microbiological data of children who underwent anticancer therapy or hematopoietic cell transplantation in 17 Polish PHO centers and six pediatric HCT centers. The data were collected in two-year intervals. : During the 10-year study period, a total of 1629 HCTs (both autologous and allogeneic) and 9614 children newly diagnosed with neoplasms were analyzed. The cumulative incidence of PSA infection was similar in both groups (6.71% in PHO vs. 6.32% in HCT, = 0.624). The total number of PSA bloodstream infections was comparable in the PHO and HCT groups (31.9% vs. 26.2%; = 0.223). In both analyzed groups, the antipseudomonal drugs of choice were as follows: meropenem, ceftazidime, and tazobactam/piperaciline in combination with other antibiotics. In the HCT group, high rates of meropenem (20.4%) and tazobactam/piperaciline (18.4%) non-susceptibility were observed. This led to colistin therapy in 5.3% of patients. There was no difference in the median antibiotic therapy time in both groups; however, the survival rates from PSA infection were significantly lower in the HCT group (89.3% vs. 96.0%, = 0.004). : Although the risk of infection and the occurrence of resistant bacterial strains in HCT patients were comparable with those in PHO patients, the outcome of PSA infections was better in the PHO setting.
在免疫功能低下的患者中，产超广谱β-内酰胺酶（PSA）感染与高复发率和高死亡率相关。关于儿科造血细胞移植受者的研究有限。开展全国性多中心研究，以分析2014年至2023年期间接受化疗（儿科血液学和肿瘤学，PHO）或接受异基因或自体造血细胞移植（HCT）治疗的儿童中PSA感染的流行病学情况。我们回顾性分析了17个波兰PHO中心和6个儿科HCT中心接受抗癌治疗或造血细胞移植的儿童的临床和微生物学数据。数据每两年收集一次。在10年的研究期间，共分析了1629例造血细胞移植（包括自体和异基因）和9614例新诊断为肿瘤的儿童。两组中PSA感染的累积发生率相似（PHO组为6.71%，HCT组为6.32%，P = 0.624）。PHO组和HCT组中PSA血流感染的总数相当（31.9%对26.2%；P = 0.223）。在两个分析组中，首选的抗假单胞菌药物如下：美罗培南、头孢他啶以及他唑巴坦/哌拉西林与其他抗生素联合使用。在HCT组中，观察到美罗培南（20.4%）和他唑巴坦/哌拉西林（18.4%）的高耐药率。这导致5.3%的患者接受黏菌素治疗。两组的中位抗生素治疗时间没有差异；然而，HCT组中PSA感染的生存率显著较低（89.3%对96.0%，P = 0.004）。尽管HCT患者的感染风险和耐药菌株的发生率与PHO患者相当，但在PHO环境中PSA感染的结果更好。
