title: Early and late invasive pneumococcal infection following stem cell transplantation: a European Bone Marrow Transplantation survey.
abstract: Streptococcus pneumoniae (S. pneumoniae) may cause severe and lethal infections months and years following stem cell transplantation (SCT). In a prospective survey over a 3.5-year period, we assessed the incidence, risk factors and outcome for invasive pneumococcal infection (IPI) following SCT. Fifty-one episodes of IPI were reported: 43 episodes after bone marrow transplantation (BMT) and 8 after peripheral blood stem cell transplantation (PBSCT); 35 after allogeneic SCT and 16 after autologous SCT. Seven IPI episodes, all bacteraemias, were defined as early, occurring 1-35 d (median 3 d) post transplantation. Forty-four episodes were defined as late (> or = 100 d post SCT), occurring 4 months to 10 years (median 17 months) post transplantation. The incidences of early and late IPI were 2.03/1000 and 8.63/1000 transplantations respectively (P = 0.001). A higher incidence of late IPI was observed after BMT than after PBSCT (10.99 versus 3.23/1000; P < 0.01) and after allogeneic versus autologous SCT (12.20 versus 4.60/1000; P < 0.01). There was a higher estimated incidence of IPI in allogeneic patients with than in those without graft-versus-host disease (GVHD) (18.85 versus 8.25/1000; P = 0.015). The mortality rate was 20%, including 2/7 of early and 8/44 of late IPI. S. pneumoniae is a rare but important complication during the aplastic phase after SCT. In conclusion, S. pneumoniae is a significant cause of morbidity late post-transplantation, especially in allogeneic patients, and particularly those with GVHD. The high IPI mortality rate, both early and late post-transplantation, requires preventive approaches, mainly effective immunization.
authors.affiliation: Department of Pediatrics, Hadassah University Hospital and Hebrew University Hadassah Medical School, Ein Karem, Jerusalem, Israel. engelhard@hadassah.org.il
authors.forename: Dan
authors.initials: D
authors.lastname: Engelhard
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: Terttu
authors.initials: T
authors.lastname: Parkalli
authors.forename: Christine
authors.initials: C
authors.lastname: Guenther
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Dekker
authors.forename: H Grant
authors.initials: HG
authors.lastname: Prentice
authors.forename: Anita
authors.initials: A
authors.lastname: Gustavsson
authors.forename: Wenzel
authors.initials: W
authors.lastname: Nurnberger
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous