1
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Hu L, Huang Q, Huang S, Feng Z. Therapeutic drug monitoring of voriconazole and CYP2C19 phenotype for dose optimization in paediatric patients. Eur J Clin Pharmacol 2023; 79:1271-1278. [PMID: 37458772 DOI: 10.1007/s00228-023-03538-9] [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: 04/21/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE The objective of this study was to evaluate factors influencing voriconazole (VRC) plasma trough concentrations and provide research data for optimizing VRC dosing in Chinese paediatric patients. METHODS Medical records of inpatients were reviewed retrospectively. Multivariate linear regression analysis was used to identify the factors contributing to the variability of VRC plasma trough concentrations. RESULTS A total of 250 VRC plasma trough concentrations from 131 paediatric patients were included in the analysis. The median VRC plasma trough concentration was 1.28 mg·L-1 (range, 0.02 to 9.69 mg·L-1). The target range was achieved in 51.6% of patients, while subtherapeutic and supratherapeutic concentrations were obtained in 40.4% and 8.0% of paediatric patients, respectively. The most commonly identified cytochrome P450 2C19 (CYP2C19) phenotype was intermediate metabolizers (IMs) (48.9%), followed by normal metabolizers (NMs) (40.5%) and poor metabolizers (PMs) (10.7%), but no ultrarapid metabolizers (UMs) were observed in our study. VRC plasma trough concentrations adjusted for dose (Cmin/D) were significantly lower in both NMs and IMs compared to PMs (PN-P < 0.001 and PI-P = 0.010, respectively). The dosage of VRC required to achieve the therapeutic range was related to age, with children aged < 6 years needing a significantly higher oral dose of VRC. The oral and intravenous maintenance doses needed to reach the therapeutic range were significantly lower than the recommended maintenance dose (P < 0.001, P < 0.001). Factors such as CYP2C19 polymorphisms, the combination of omeprazole, levels of albumin and alanine aminotransferase, were found to affect VRC exposure and explained some of the variability. CONCLUSIONS The VRC plasma trough concentration is significantly influenced by the CYP2C19 phenotype. The recommended maintenance dose for pediatric patients may not be appropriate for Chinese patients. To increase the probability of achieving the therapeutic range for VRC plasma trough concentration, the administration of VRC should consider the age of paediatric patients and the presence of CYP2C19 polymorphisms.
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Affiliation(s)
- Lin Hu
- Department of Pharmacy, the First Hospital of Changsha, Changsha, Hunan, China.
| | - Qi Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shiqiong Huang
- Department of Pharmacy, the First Hospital of Changsha, Changsha, Hunan, China
| | - Zeying Feng
- Clinical Trial Institution Office, Liuzhou Hospital of Guangzhou Women and Children's Medical Center, Liuzhou, Guangxi, China.
- Center of Clinical Pharmacology, the Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Ricard N, Zebali L, Renard C, Goutagny MP, Benezech S, Bertrand Y, Philippe M, Domenech C. New Perspectives on Primary Prophylaxis of Invasive Fungal Infection in Children Undergoing Hematopoietic Stem Cell Transplantation: A 10-Year Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15072107. [PMID: 37046769 PMCID: PMC10093632 DOI: 10.3390/cancers15072107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Allogenic hematopoietic stem cell transplantation (a-HCT) remains a therapeutic treatment for many pediatric hematological diseases. The occurrence of invasive fungal infections (IFIs) is a complication for which ECIL-8 recommends primary antifungal prophylaxis. In this study, we evaluated the impact of our local strategy of not systematically administering primary antifungal prophylaxis in children undergoing a-HCT on the occurrence and mortality of IFIs. Methods: We performed a retrospective monocentric study from 2010 to 2020. We retained all proven and probable IFIs diagnosed during the first year post a-HCT. Results: 308 patients were included. Eighteen patients developed twenty IFIs (thirteen proven, seven probable) (6.5%) among which aspergillosis (n = 10, 50%) and candidosis (n = 7, 35%) were the most frequently diagnosed infections. Only 2% of children died because of an IFI, which represents 14% of all deaths. Multivariate analysis found that age > 10 years (OR: 0.29), the use of a therapeutic antiviral treatment (OR: 2.71) and a low neutrophil count reconstitution (OR: 0.93) were significantly associated with the risk of IFI occurrence. There was also a trend of malignant underlying disease and status ≥ CR2 but it was not retained in multivariate analysis. Conclusions: IFI occurrence was not higher in our cohort than what is reported in the literature with the use of systematic antifungal prophylaxis, with a good survival rate nonetheless. Thus, a prophylaxis could be considered for children with a high risk of IFI such as those aged over 10 years.
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Affiliation(s)
- Noémi Ricard
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
| | - Lelia Zebali
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Cécile Renard
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Marie-Pierre Goutagny
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Sarah Benezech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Yves Bertrand
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Michael Philippe
- Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
| | - Carine Domenech
- The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France; (L.Z.)
- Faculty of Medicine and Maieutics Charles Mérieux Lyon Sud, Université Claude Bernard Lyon 1, 69921 Lyon, France
- International Center of Research in Infectiology, Université Lyon 1, INSERM U 1111, CNRS UMR 5308, 69007 Lyon, France
- Correspondence: ; Tel.: +33-469-166-567; Fax: +33-478-782-703
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3
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Popova MO, Rogacheva YA. Invasive mycoses in patients with hematological malignancies and recipients of hematopoietic stem cell transplantation: results of a systematic review, literature review and meta-analysis. ONCOHEMATOLOGY 2023. [DOI: 10.17650/1818-8346-2023-18-1-101-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- M. O. Popova
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - Yu. A. Rogacheva
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
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Ferreras-Antolín L, Irwin A, Atra A, Chapelle F, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Rompola M, Vergnano S, Whittaker E, Warris A. Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in Children. Pediatr Infect Dis J 2022; 41:e69-e74. [PMID: 34784303 PMCID: PMC8826618 DOI: 10.1097/inf.0000000000003402] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize prescription behaviors. METHODS A prospective modified weekly Point Prevalence Survey capturing antifungal prescriptions for children (> 90 days to < 18 years of age) in 12 centers in England during 26 consecutive weeks was performed. Demographic, diagnostic and treatment information was collected for each patient. Data were entered into an online REDCap database. RESULTS One thousand two hundred fifty-eight prescriptions were included for 656 pediatric patients, 44.9% were girls, with a median age of 6.4 years (interquartile range, 2.5-11.3). Most common underlying condition was malignancy (55.5%). Four hundred nineteen (63.9%) received antifungals for prophylaxis, and 237 (36.1%) for treatment. Among patients receiving antifungal prophylaxis, 40.2% did not belong to a high-risk group. In those receiving antifungal treatment, 45.9%, 29.4%, 5.1% and 19.6% had a diagnosis of suspected, possible, probable of proven invasive fungal disease (IFD), respectively. Proven IFD was diagnosed in 78 patients, 84.6% (n = 66) suffered from invasive candidiasis and 15.4% (n = 12) from an invasive mold infection. Liposomal amphotericin B was the most commonly prescribed antifungal for both prophylaxis (36.6%) and empiric and preemptive treatment (47.9%). Throughout the duration of the study, 72 (11.0%) patients received combination antifungal therapy. CONCLUSIONS Antifungal use in pediatric patients is dominated by liposomal amphotericin B and often without evidence for the presence of IFD. A significant proportion of prophylactic and empiric antifungal use was seen in pediatric patients not at high-risk for IFD.
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Affiliation(s)
- Laura Ferreras-Antolín
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Adam Irwin
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Ayad Atra
- Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, United Kingdom
| | - Faye Chapelle
- Department of Infectious Diseases and Immunology, Evelina Children Hospital, London, United Kingdom
| | - Simon B. Drysdale
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Marieke Emonts
- Department of Paediatric Immunology, Infectious Diseases and Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paddy McMaster
- Department of Paediatric Infectious Diseases, Royal Manchester Childrens´ Hospital, Manchester, United Kingdom
| | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Menie Rompola
- Dept. of Paediatric Haematology and Oncology, Leeds General Infirmary, Leeds, United Kingdom
| | - Stefania Vergnano
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust and Section of Paediatrics, Department of Infectious Diseases, Imperial College, London, United Kingdom
| | - Adilia Warris
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
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6
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Yeoh DK, Moore AS, Kotecha RS, Bartlett AW, Ryan AL, Cann MP, McMullan BJ, Thursky K, Slavin M, Blyth CC, Haeusler GM, Clark JE. Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10-year review. Pediatr Blood Cancer 2021; 68:e29275. [PMID: 34357688 DOI: 10.1002/pbc.29275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive fungal disease (IFD) is a common and important complication in children with acute myeloid leukaemia (AML). We describe the epidemiology of IFD in a large multicentre cohort of children with AML. METHODS As part of the retrospective multicentre cohort TERIFIC (The Epidemiology and Risk factors for Invasive Fungal Infections in immunocompromised Children) study, proven/probable/possible IFD episodes occurring in children with primary or relapsed/refractory AML from 2003 to 2014 were analysed. Crude IFD prevalence, clinical characteristics, microbiology and treatment were assessed. Kaplan-Meier survival analysis was used to estimate 6-month survival. RESULTS There were 66 IFD episodes diagnosed in 63 children with AML. The majority (75.8%) of episodes occurred in the context of primary AML therapy. During primary AML therapy, the overall prevalence was 20.7% (95% CI 15.7%-26.5%) for proven/probable/possible IFD and 10.3% (95% CI 6.7%-15.0%) for proven/probable IFD. Of primary AML patients, 8.2% had IFD diagnosed during the first cycle of chemotherapy. Amongst pathogens implicated in proven/probable IFD episodes, 74.4% were moulds, over a third (37.9%) of which were non-Aspergillus spp. Antifungal prophylaxis preceded 89.4% of IFD episodes, most commonly using fluconazole (50% of IFD episodes). All-cause mortality at 6 months from IFD diagnosis was 16.7% with IFD-related mortality of 7.6% (all in cases of proven IFD). CONCLUSIONS IFD is a common and serious complication during paediatric AML therapy. Mould infections, including non-Aspergillus spp. predominated in this cohort. A systematic approach to the identification of patients at risk, and a targeted prevention strategy for IFD is needed.
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Affiliation(s)
- Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andrew S Moore
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western, Perth, Western Australia, Australia
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Anne L Ryan
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Megan P Cann
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Brendan J McMullan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Thursky
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Health and Medical Research Council National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Monica Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria.,The Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Julia E Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
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7
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Olivier-Gougenheim L, Rama N, Dupont D, Saultier P, Leverger G, AbouChahla W, Paillard C, Gandemer V, Theron A, Freycon C, Pluchart C, Blouin P, Pellier I, Thouvenin-Doulet S, Desplantes C, Ducassou S, Oudot C, Rouger-Gaudichon J, Cheikh N, Poiree M, Schneider P, Plat G, Contet A, Rialland F, Gouache E, Brethon B, Bertrand Y, Domenech C. Invasive Fungal Infections in Immunocompromised Children: Novel Insight Following a National Study. J Pediatr 2021; 236:204-210. [PMID: 33991540 DOI: 10.1016/j.jpeds.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To obtain a national overview of the epidemiology and management of invasive fungal infections (IFIs) in France for severely immunocompromised children who were treated for acute leukemia or had undergone allogeneic hematopoietic stem cell transplantation (a-HSCT). STUDY DESIGN We performed a national multicenter retrospective study to collect epidemiologic data for proven and probable IFIs in children with acute leukemia under first- line or relapse treatment or who had undergone a-HSCT. We also conducted a prospective practice survey to provide a national overview of IFI management in pediatric hematology units. RESULTS From January 2014 to December 2017, 144 cases of IFI were diagnosed (5.3%) in 2721 patients, including 61 cases of candidiasis, 60 cases of aspergillosis, and 23 cases of infection with "emergent" fungi, including 10 cases of mucormycosis and 6 cases of fusariosis. The IFI rate was higher in patients with acute myelogenous leukemia (12.9%) (OR, 3.24; 95% CI, 2.15-4.81; P < .0001) compared with the rest of the cohort. Patients undergoing a-HSCT had an IFI rate of only 4.3%. In these patients, the use of primary antifungal prophylaxis (principally fluconazole) was associated with a lower IFI rate (OR, 0.28; 95% CI, 0.14-0.60; P = 4.90 ×10-4) compared with a-HSCT recipients who did not receive antifungal prophylaxis. The main cause of IFI in children receiving prophylaxis was emergent pathogens (41%), such as mucormycosis and fusariosis, which were resistant to the prophylactic agents. CONCLUSIONS The emerging fungi and new antifungal resistance profiles uncovered in this study should be considered in IFI management in immunocompromised children.
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Affiliation(s)
- Laura Olivier-Gougenheim
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France.
| | - Nicolas Rama
- Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
| | - Damien Dupont
- Institut des Agents Infectieux, Parasitology-Mycology Unit, Lyon, France
| | - Paul Saultier
- Pediatric Hematology-OncologyUnit, CHU Marseille, Marseille, France
| | - Guy Leverger
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | | | | | | | - Alexandre Theron
- Pediatric Hematology-Oncology Unit, CHU Montpellier, Montpellier, France
| | - Claire Freycon
- Pediatric Hematology-Oncology Unit, CHU Grenoble, Grenoble, France
| | - Claire Pluchart
- Pediatric Hematology-Oncology Unit, Institut Jean Godinot, CHU Reims, Reims, France
| | - Pascale Blouin
- Pediatric Hematology-Oncology Unit, CHU Tours, Tours, France
| | | | | | | | | | - Caroline Oudot
- Pediatric Hematology-Oncology Unit, CHU Limoges, Limoges, France
| | | | - Nathalie Cheikh
- Pediatric Hematology-Oncology Unit, CHU Besançon, Besançon, France
| | - Maryline Poiree
- Pediatric Hematology-Oncology Unit, CHU Lenval Nice, Nice, France
| | | | - Genevieve Plat
- Pediatric Hematology-Oncology Unit, CHU Toulouse, Toulouse, France
| | - Audrey Contet
- Pediatric Hematology-Oncology Unit, CHU Nancy, Nancy, France
| | - Fanny Rialland
- Pediatric Hematology-Oncology Unit, CHU Nantes, Nantes, France
| | - Elodie Gouache
- Pediatric Hematology-Oncology Unit, AP-HP Trousseau, Paris, France
| | - Benoit Brethon
- Pediatric Hematology Unit, AP-HP Robert Debré, Paris, France
| | - Yves Bertrand
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Carine Domenech
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Apoptosis, Cancer and Development Laboratory, INSERM U1052, CNRS UMR5286, CRCL, Lyon, France
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8
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Gałązka P, Styczyński J, Czyżewski K, Salamonowicz-Bodzioch M, Frączkiewicz J, Zając-Spychała O, Zaucha-Prażmo A, Goździk J, Biliński J, Basak GW. Impact of decontamination therapy on gastrointestinal acute graft-versus-host disease after allogeneic hematopoietic cell transplantation in children: Decontamination therapy in allo-HCT. Curr Res Transl Med 2021; 69:103298. [PMID: 34144374 DOI: 10.1016/j.retram.2021.103298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Gut colonization with antibiotic-resistant bacteria (ARB) is associated with a significantly decreased overall survival in adult patients undergoing allo-HCT because of an increased treatment-related mortality. OBJECTIVE The objective of this multicenter study was the analysis of impact of gut colonization status and the use of antibiotics on development of gastro-intestinal (GI) graft-versus-host disease (GVHD) of allo-HCT in children. METHODS All consecutive patients who underwent allo-HCT over a period of three years in all pediatric HCT centers in Poland were analyzed for the impact of gut colonization on GI GVHD, with respect to standard of care including prophylaxis of infections and supportive therapy. RESULTS At the time of allo-HCT, 44.2% of pediatric patients were colonized by ARB. Decontamination therapy with antibiotics was applied in 78% of children. Gut decontamination prophylactic therapy with antibiotics decreased the risk of acute GI GVHD. The use of gentamicin contributed to decreased rate of GVHD, while the use of ciprofloxacin and colistin contributed to increased incidence of GVHD after allo-HCT in children. Sepsis with ARB and non-MFD transplant contributed significantly to worse survival, while neither colonization nor gut decontamination had an impact on overall survival. CONCLUSIONS Gut decontamination therapy contributed to lower incidence of acute GI GVHD in children undergoing allo-HCT, and the use of specific antibiotics might be responsible for this effect.
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Affiliation(s)
- Przemysław Gałązka
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | | | - Jowita Frączkiewicz
- Department of Pediatric Transplantation, Oncology and Hematology, Medical University, Wroclaw, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland
| | - Jolanta Goździk
- Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Jaroslaw Biliński
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warszawa, Warszawa, Poland
| | - Grzegorz W Basak
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warszawa, Warszawa, Poland
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9
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Febrile Neutropenia in Acute Leukemia. Epidemiology, Etiology, Pathophysiology and Treatment. Mediterr J Hematol Infect Dis 2020; 12:e2020009. [PMID: 31934319 PMCID: PMC6951355 DOI: 10.4084/mjhid.2020.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial, and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. In this review, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.
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