1
|
Yang M, Xin L, Li H, Lu X, Pan X, Lei S, Li Y, Zhu L, Zhu Q, Jiang R, Jia Z, Cheng G, Zeng L, Zhang L. Risk factors for bloodstream infection in paediatric haematopoietic stem cell transplantation: a systematic review and meta-analysis. J Hosp Infect 2023; 139:11-22. [PMID: 37308062 DOI: 10.1016/j.jhin.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Haematopoietic stem cell transplantation (HSCT), a standard treatment for paediatric haematological diseases, is highly associated with bloodstream infection (BSI), which may increase mortality. AIM To explore the risk factors for BSI in paediatric HSCT recipients. METHODS Three English databases and four Chinese databases were searched from inception to March 17th, 2022. Eligible studies included randomized controlled trials, cohort studies, and case-control studies that enrolled HSCT recipients aged ≤18 years and reported BSI risk factors. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), certainty of body of evidence was assessed. FINDINGS Fourteen studies involving 4602 persons were included. The incidences of BSI and associated mortality in paediatric HSCT recipients were approximately 10-50% and 5-15%, respectively. Meta-analysis of all studies revealed that previous BSI before HSCT (relative effect (RE): 2.28; 95% confidence interval (CI) 1.19-4.34, moderate certainty) and receiving an umbilical cord blood transplant (RE: 1.55; 95% CI: 1.22-1.97, moderate certainty) were probably associated with an increased risk of BSI. Meta-analysis of studies with low risk of bias reassured that previous BSI before HSCT probably increased the risk of BSI (RE: 2.28; 95% CI: 1.19-4.34, moderate certainty), and revealed that steroid use (RE: 2.72; 95% CI: 1.31-5.64, moderate certainty) was likely a risk factor whereas autologous HSCT was probably a protective factor of BSI (RE: 0.65; 95% CI: 0.45-0.94, moderate certainty). CONCLUSION These findings could inform the management of paediatric HSCT recipients, helping identify who may benefit from prophylactic antibiotics.
Collapse
Affiliation(s)
- M Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China; West China School of Medicine, Sichuan University, Chengdu 610000, China
| | - L Xin
- Department of Clinical Pharmacy, Affiliated Hospital of Yunnan University, Kunming 650000, China
| | - H Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
| | - X Lu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China; Department of Paediatric Haematology and Oncology, West China Second Hospital, Sichuan University, Chengdu 610000, China
| | - X Pan
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China
| | - S Lei
- West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - Y Li
- West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - L Zhu
- West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - Q Zhu
- West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - R Jiang
- West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - Z Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China; West China School of Pharmacy, Sichuan University, Chengdu 610000, China
| | - G Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China; Department of Paediatrics, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Laboratory of Molecular Translational Medicine, Centre for Translational Medicine, Sichuan University, Chengdu 610000, China
| | - L Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China.
| | - L Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610000, China; Evidence-Based Pharmacy Centre, West China Second University Hospital, Sichuan University, Chengdu 610000, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu 610000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610000, China; Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu 610000, China.
| |
Collapse
|
2
|
Takahashi T, Pereda MA, Bala N, Nagarajan S. In-hospital mortality of hematopoietic stem cell transplantation among children with nonmalignancies: A nationwide study in the United States from 2000 to 2012. Pediatr Blood Cancer 2019; 66:e27626. [PMID: 30740860 DOI: 10.1002/pbc.27626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplant (HSCT) can cure or alleviate a wide range of nonmalignant childhood conditions. However, few studies have examined longitudinal national trends of frequency or short-term complications of HSCT before 2006 when an HSCT became a reportable procedure by US law. By using a US nationally representative database, we conducted nationwide longitudinal analyses on demographics, in-hospital mortality, and short-term complications in nonmalignant HSCT from 2000 to 2012. PROCEDURE We analyzed 2504 admissions for children < 20 years old who underwent an allogeneic HSCT for a nonmalignant condition by using the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009, and 2012. Changes in in-hospital mortality and other outcomes were assessed over the study period using weighted analyses, which enabled generation of national estimates in each year. RESULTS The number of admissions for HSCT increased from 334 to 667 from 2000 to 2012, respectively; among them, the use of bone marrow decreased (66.5% to 34.1%, P < 0.001). In-hospital mortality declined (13.4% to 7.1%, P = 0.04), as did bacteremia (28.7% to 10.1%, P < 0.001) and vascular catheter infections (18.8% to 8.7%, P = 0.006), but cytomegalovirus infections increased (4.9% to 15.9%, P < 0.001), as did adenovirus infections (1.8% to 6.9%, P < 0.001) from 2000 to 2012. CONCLUSION Population-based analyses demonstrated a substantial expansion of the utilization of HSCT occurred for pediatric nonmalignancies from 2000 to 2012 in the United States, whereas the in-hospital mortality declined by approximately a half. Further research is needed to identify distinct contributing factors.
Collapse
Affiliation(s)
- Takuto Takahashi
- Division of Hematology and Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Maria A Pereda
- Division of Hematology and Oncology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Natasha Bala
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, New York
| | - Sairaman Nagarajan
- Division of Allergy and Immunology, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, New York
| |
Collapse
|
3
|
Satwani P, Freedman JL, Chaudhury S, Jin Z, Levinson A, Foca MD, Krajewski J, Sahdev I, Talekar MK, Gardenswartz A, Silverman J, Hayes M, Dvorak CC. A Multicenter Study of Bacterial Blood Stream Infections in Pediatric Allogeneic Hematopoietic Cell Transplantation Recipients: The Role of Acute Gastrointestinal Graft-versus-Host Disease. Biol Blood Marrow Transplant 2017; 23:642-647. [DOI: 10.1016/j.bbmt.2017.01.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 02/08/2023]
|
4
|
Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis. Bone Marrow Transplant 2017; 52:1091-1106. [PMID: 28346417 DOI: 10.1038/bmt.2017.14] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/12/2017] [Indexed: 12/14/2022]
Abstract
Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.
Collapse
|
5
|
Sano H, Hilinski JA, Applegate K, Chiang KY, Haight A, Qayed M, Horan J. African American Race Is a Newly Identified Risk Factor for Postengraftment Blood Stream Infections in Pediatric Allogeneic Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2017; 23:357-360. [DOI: 10.1016/j.bbmt.2016.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022]
|
6
|
Chang AK, Foca MD, Jin Z, Vasudev R, Laird M, Schwartz S, Qureshi M, Kolb M, Levinson A, Bhatia M, Kung A, Garvin J, George D, Della-Latta P, Whittier S, Saiman L, Satwani P. Bacterial bloodstream infections in pediatric allogeneic hematopoietic stem cell recipients before and after implementation of a central line-associated bloodstream infection protocol: A single-center experience. Am J Infect Control 2016; 44:1650-1655. [PMID: 27378008 DOI: 10.1016/j.ajic.2016.04.229] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are only few reports describing the influence of central line-associated bloodstream infection (CLABSI) prevention strategies on the incidence of bacterial bloodstream infections (BBSIs). METHODS We performed a retrospective cohort study among pediatric recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT) to assess potential changes in BBSI rates during 3 time periods: pre-CLABSI prevention era (era 1, 2004-2005), CLABSI prevention implementation era (era 2, 2006-2009), and maintenance of CLABSI prevention era (era 3, 2010-2012). BBSI from day 0-365 following allo-HCT were studied. The comparison of person-years incidence rates among different periods was carried out by Poisson regression analysis. RESULTS The mean age of patients was 10.0 years. During the study period, 126 (65%) of 190 patients had at least a single BBSI. From day 0-30, day 31-100, day 101-180, and day 181-365, 20%, 28%, 30%, and 17% of patients, respectively, experienced BBSIs. The rate of Staphylococcus epidermidis and gram-negative pathogens significantly declined from 3.16-0.93 and 6.32-2.21 per 100 person-months during era 1 and era 3, respectively (P = .001). CONCLUSIONS Patients undergoing allo-HCT during era 3 were associated with decreased risk of BBSI (P = .012). Maintenance of CLABSI protocols by nursing staff and appropriate education of other care providers is essential to lower incidence of BBSI in this high-risk population, and further strategies to decrease infection burden should be studied.
Collapse
Affiliation(s)
- Alicia K Chang
- Department of Pediatrics, Columbia University, New York, NY
| | - Marc D Foca
- Department of Pediatrics, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Rahul Vasudev
- Department of Pediatrics, Columbia University, New York, NY
| | - Mary Laird
- Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Sharon Schwartz
- Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | | | - Michelle Kolb
- Department of Nursing, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Anya Levinson
- Department of Pediatrics, Columbia University, New York, NY
| | - Monica Bhatia
- Department of Pediatrics, Columbia University, New York, NY
| | - Andrew Kung
- Department of Pediatrics, Columbia University, New York, NY
| | - James Garvin
- Department of Pediatrics, Columbia University, New York, NY
| | - Diane George
- Department of Pediatrics, Columbia University, New York, NY
| | | | - Susan Whittier
- Department of Pathology, Columbia University, New York, NY
| | - Lisa Saiman
- Department of Pediatrics, Columbia University, New York, NY; Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY
| | - Prakash Satwani
- Department of Pediatrics, Columbia University, New York, NY.
| |
Collapse
|
7
|
Bacteremia during neutropenic episodes in children undergoing hematopoietic stem cell transplantation with ciprofloxacin and penicillin prophylaxis. Int J Hematol 2016; 105:213-220. [PMID: 27771837 DOI: 10.1007/s12185-016-2113-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
Bacteremia during neutropenic episodes is a cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). We have used oral ciprofloxacin and penicillin V, from the start of the conditioning regimen until engraftment, for the prophylaxis of bacterial infection. The objective of this study was to retrospectively analyze the prevalence of and risk factors for breakthrough bacteremia during neutropenic episodes in autologous and allogeneic HSCT patients. There were 215 patients enrolled, with a median age of 8.32 years (range 0.51-21.64 years) between 2002 and 2014. The common underlying diseases were thalassemia and acute leukemia. Bacteremia was documented in 33 patients (15.3 %), with 39 microorganisms isolated. Escherichia coli (28.2 %) and Streptococcus viridans (12.8 %) were the most commonly isolated Gram-negative and Gram-positive bacteria, respectively. Multidrug resistant strains were found in 32 and 14.3 % of Gram-negative and Gram-positive bacteria, respectively. Risk factors for bacteremia were receiving anti-thymocyte globulin (ATG) [odds ratio (OR) 2.44, 95 % confidence interval (CI) 1.06-5.65, P = 0.037] and umbilical cord blood as a stem cell graft (OR 6.60, 95 % CI 1.04-41.83, P = 0.045). In conclusion, the prevalence of bacteremia was 15.3 % and the use of ATG and cord blood were risk factors for bacteremia during neutropenic episodes.
Collapse
|
8
|
Pre-engraftment bloodstream infections in acute leukemia patients undergoing unrelated cord blood transplantation following intensified myeloablative conditioning without ATG. Ann Hematol 2016; 96:115-124. [DOI: 10.1007/s00277-016-2828-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/19/2016] [Indexed: 12/21/2022]
|
9
|
Hussein AA, Al-Antary ET, Najjar R, Al-Zaben A, Frangoul H. Incidence and risk factors of bacterial infections in children following autologous hematopoietic stem cell transplantation: Single-center experience from Jordan. Pediatr Transplant 2016; 20:683-6. [PMID: 27273463 DOI: 10.1111/petr.12727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Bacterial infection is a serious sequela following AHSCT; however, limited data are available regarding pediatric recipients, especially in developing countries. We retrospectively analyzed the incidence and risk factors of bacterial infections during the first 100 days after AHSCT in children at KHCC in Amman, Jordan between January, 2005 and September, 2013. A total of 65 patients were identified, with median age of four yr (1-17). Forty-seven patients (72.3%) had solid tumors and 18 (27.7%) had lymphoma. Bacterial infections were documented in 33 patients (50%), with a total of 63 episodes. Gram-negative infection (57.1%) was more prevalent than Gram-positive infection (38%). The risk of bacterial infections was higher among patients less than five yr of age (p = 0.028) and those who developed hypogammaglobulinemia requiring IVIG replacement (p = 0.001). Patients with solid tumors developed more bacterial infections compared to patients with lymphoma (p = 0.0057). No deaths were attributed to bacterial infection. Bacterial infection rate is high among recipients of AHSCT in Jordan with Gram-negative bacteria being the most common.
Collapse
Affiliation(s)
- Ayad Ahmed Hussein
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - Eman T Al-Antary
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - Rula Najjar
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Abdulhadi Al-Zaben
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - Haydar Frangoul
- Pediatric Stem Cell Transplant Program, TriStar Children's Hospital and Sarah Cannon Research Institute, Nashville, TN, USA
| |
Collapse
|
10
|
Levinson A, Pinkney K, Jin Z, Bhatia M, Kung AL, Foca MD, George D, Garvin JH, Sosna J, Karamehmet E, Robinson C, Satwani P. Acute Gastrointestinal Graft-vs-Host Disease Is Associated With Increased Enteric Bacterial Bloodstream Infection Density in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients. Clin Infect Dis 2015; 61:350-7. [DOI: 10.1093/cid/civ285] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/09/2015] [Indexed: 12/26/2022] Open
|
11
|
Bloodstream infection after stem cell transplantation in children with idiopathic aplastic anemia. Biol Blood Marrow Transplant 2014; 20:1145-9. [PMID: 24727336 DOI: 10.1016/j.bbmt.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/03/2014] [Indexed: 11/20/2022]
Abstract
Bloodstream infection (BSI) is the most common infectious complication of hematopoietic stem cell transplantation (HSCT) and can cause substantial morbidity and mortality. Identification of risk factors for BSI might be helpful in efforts to reduce transplantation-related death. This study analyzed the incidence of BSI and risk factors for BSI after HSCT in pediatric patients with aplastic anemia (AA). BSI occurred in 39 of the 351 patients with AA (11.1%). Onset of BSI occurred at a median of 8 days after HSCT (range, 0 to 92 days). The 5-year overall survival rate was lower in patients with BSI than in patients without BSI (63.32% ± 7.90% versus 93.35% ± 1.44%; P < .0001). Univariate analysis identified the following variables as associated with BSI: history of immunosuppressive therapy with antithymocyte globulin (ATG), transplantation from an unrelated donor, frequent blood transfusion before transplantation, major or major plus minor ABO type mismatch, graft-versus-host disease prophylaxis with tacrolimus and without cyclosporine, and long interval from diagnosis to transplantation. Among these factors, long interval from diagnosis to transplantation was the sole statistically significant risk factor for BSI on multivariate analysis. In patients who underwent HSCT from a related donor, age ≥14 years at transplantation was risk factor for BSI. In contrast, history of immunosuppressive therapy with ATG, frequent blood transfusion before HSCT, graft failure, and major or major plus minor ABO type mismatch were risk factors for BSI in patients who underwent HSCT from an unrelated donor. Because the overall 5-year survival rate without BSI was >90%, even in patients who were received a transplant from an unrelated donor, control of BSI is very important for successful HSCT in pediatric patients with AA.
Collapse
|
12
|
Paolillo R, Vasco M, Napoli C. Specific Microorganism Strains for Achieving Specific Health Targets in Children Undergoing Hematopoietic Stem Cell Transplant. EXP CLIN TRANSPLANT 2013; 11:469-70. [DOI: 10.6002/ect.2013.0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|