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Varla H, Meena S, Swaminathan VV, Chandar R, Munnusamy MK, Ramakrishnan B, Karmegam D, Grace J, Jayakumar I, Uppuluri R, Raj R. Risk Factors for Neutropenic Sepsis Related Mortality in Children Undergoing Allogenic Hematopoietic Stem Cell Transplantation. Indian J Hematol Blood Transfus 2023; 39:1-6. [PMID: 36699434 PMCID: PMC9868024 DOI: 10.1007/s12288-021-01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/19/2021] [Indexed: 01/28/2023] Open
Abstract
We aimed to analyze infections in children undergoing hematopoietic stem cell transplantation (HSCT) until engraftment. The spectrum and risk factors associated will help plan interventions to reduce mortality. We performed a retrospective analysis on the infections, associated risk factors, and mortality until engraftment in children up to 18 years of age undergoing HSCT from January 2017 to August 2020. A total of 399 children were included, with a male: female ratio of 1.9:1, with matched related donor HSCT in 36.6%, a matched unrelated donor in 18.3%, and haploidentical HSCT in 38.1% of children. Culture positive bacteremia was documented in 22.1% transplants with gram-negative bacteria (GNB) isolated in 71/88 (80%). Among the GNB, the predominant organism was Klebsiella pneumonia in 38 (53%), E.coli in 16 (22%), Pseudomonas in 9 (12%). Carbapenem resistance was documented in 24/71 (33%). The incidence of possible, probable, and proven fungal infections in the cohort was 63 (15%), 28 (7%), and 6 (1.5%), respectively. Mortality up to engraftment due to sepsis in our cohort is 3.3% (n = 13). There was a significant association between mortality and a perianal focus (30.8%, p value 0.029) and the presence of carbapenem resistance (38%, p value 0.002). Mortality among those who developed proven fungal infections was significantly higher than those with bacteremia (p value 0.004). Our study has identified fungal sepsis and carbapenem-resistant GNB sepsis as high-risk groups for mortality. Risk directed interventions in these groups would help ensure survival and optimal outcomes.
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Affiliation(s)
- Harika Varla
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Satishkumar Meena
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Venkateswaran Vellaichamy Swaminathan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Rumesh Chandar
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Mohan Kumar Munnusamy
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | | | - Deepa Karmegam
- Department of Nursing, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Jerlin Grace
- Department of Nursing, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Indira Jayakumar
- Department of Pediatric Critical Care, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Ramya Uppuluri
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
| | - Revathi Raj
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Padma Complex, Anna Salai, 320, Teynampet, Chennai, 600035 India
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Das B, Ghafur A, S. J, Easow JM. A Case of Severe Aeromonas Bacteremia with Necrotizing Fasciitis of Lower Limb and Fournier ' s Gangrene in a Post-Allogenic Unrelated Hematopoietic Stem Cell Transplant Recipient. South Asian J Cancer 2022; 11:274-275. [PMID: 36588616 PMCID: PMC9803536 DOI: 10.1055/s-0042-1743164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Bikram DasBackground Aeromonas is a water-dwelling Gram-negative bacillus primarily associated with gastrointestinal tract diseases. Aeromonas sobria causing gastroenteritis has been reported in India. In immunocompromised host, Aeromonas sobria can also present with severe necrotizing skin and soft tissue infection with a high mortality rate. We report a case of Aeromonas sobria sepsis with skin and soft tissue infection in the background of immunosuppression. Case Presentation Fifty-year-old male who underwent an unrelated donor peripheral stem cell transplant for relapsed pre-B acute lymphoblastic leukemia in complete clinical remission on graft versus host disease prophylaxis, post-white blood cell engraftment presented with acute onset lethargy, lower limb pain without fever, or any skin changes initially. He rapidly worsened clinically over few days and developed sepsis, multiorgan dysfunction with the appearance of erythema and blister over the lower limb, and Fournier's gangrene of scrotum. He was found to have Aeromonas sobria bacteremia with isolated resistance to carbapenems while sensitive to all other classes of antibiotics. Despite appropriate antibiotic therapy and supportive measures, he succumbed to death for this invasive bacterial disease. Conclusion Aeromonas should be considered a cause of sepsis in immunosuppressed hosts, especially those with hematological malignancy presenting with necrotizing skin and soft tissue infection. Considering the virulence of this pathogen, despite the very susceptible antibiogram, such patients must be managed aggressively. Early recognition of the disease with a combination of medical and surgical management might help to improve the outcome.
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Affiliation(s)
- Bikram Das
- Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu,Address for correspondence Bikram Das, MBBS, DTCD, MD (Tropical Medicine), FNB trainee (Infectious Diseases) Department of Infectious diseases, Apollo HospitalsChennaiTamil Nadu
| | - Abdul Ghafur
- Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu
| | - Jeyasankar S.
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu
| | - Jose M. Easow
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu
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Garg V, Kodan P, Pushpam D, Bakhshi S, Kumar L, Sharma A, Gupta G, Gupta N. Impact of microbial contamination of haematopoietic stem cells on post-transplant outcomes: A retrospective study from tertiary care centre in India. Transfus Med 2021; 31:377-382. [PMID: 34396610 DOI: 10.1111/tme.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/17/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Haematopoietic stem cells (HSC) may act as a source of infection for the recipient due to manipulation at multiple levels from collection to infusion. Due to the high risk of contamination cultures are usually taken during multiple steps. The clinical significance of microbial contamination of HSC on the post-transplant course and the role of prophylactic antibiotics is relatively unknown. AIMS AND METHODS The aim of our study is to investigate the incidence of microbial contamination of haematopoietic stem cell and to assess its impact on the post-transplant febrile neutropenia, engraftment kinetics, hospitalisation and day 100 mortality. Details of all patients admitted in the bone marrow transplantation unit of a tertiary care centre in India between January 2014 and December 2018 were collected from case records. RESULTS Of the 1306 stem cell harvests from 503 patients sent for culture, 17 harvests (1.3%) were found to have a culture positive report. Sixteen patients had undergone autologous transplant. Multiple myeloma was most common indication of HSC transplant followed by Non-Hodgkin Lymphoma (NHL). Twelve of 17 HSC cultures were positive at the time of infusion and five were positive at the time of harvest. The five HSC that were culture positive at the time of harvest were culture negative at the time of infusion. Gram-positive organisms were isolated in six cultures and gram-negative in rest. All patients developed febrile neutropenia post-transplantation between day 1 and day 7. The median time of onset of fever was day +5 (1-7), the median duration of fever was 4 days (2-7), the median duration of antibiotic use was 11 days (9-16). Median day for neutrophil engraftment was 11 days (9-16), the median day for platelet engraftment was 14 days (10-25) and median duration of hospitalisation was 15 days (12-78). All patients were alive at day 100 of transplant. CONCLUSION This study shows that there appears to be minimal impact of culture positive HSC on transplant related outcomes in terms of engraftment kinetics, duration of hospitalisation and day 100 mortality. Discarding of contaminated HSC may not be required, though on development of febrile neutropenia appropriate antibiotics should be administered based on sensitivity pattern of HSC culture. Larger prospective studies are needed to determine the clinical relevance of such contaminations. Emphasis should be laid on better infection control practices to minimise contamination rates.
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Affiliation(s)
- Vikas Garg
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | | | - Deepam Pushpam
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, BRAIRCH, AIIMS, Delhi, India
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Korula A, Perumalla S, Devasia AJ, Abubacker FN, Lakshmi KM, Abraham A, Mathews V, Srivastava A, Anandan S, Veeraraghavan B, George B. Drug‐resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants. Transpl Infect Dis 2020; 22. [DOI: 10.1111/tid.13273] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/24/2020] [Indexed: 08/30/2023]
Affiliation(s)
- Anu Korula
- Department of Haematology Christian Medical College and Hospital Vellore India
| | | | - Anup J. Devasia
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Fouzia N. Abubacker
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Kavitha M. Lakshmi
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Aby Abraham
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Vikram Mathews
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Alok Srivastava
- Department of Haematology Christian Medical College and Hospital Vellore India
| | - Shalini Anandan
- Microbiology Christian Medical College and Hospital Vellore India
| | | | - Biju George
- Department of Haematology Christian Medical College and Hospital Vellore India
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