title: Surveillance cultures in pediatric allogeneic hematopoietic stem cell transplantation.
abstract: The value of surveillance cultures in predicting systemic infections and in guiding antimicrobial treatment is controversial. We investigated 57 pediatric allo-SCTs between 2007 and 2009. ALL (34), AML (5), and severe aplastic anemia (4) were the largest patient groups. Conditioning was TBI-based in 87% and 54% developed GVHD (21% grade III-IV). Of the 2594 weekly colonization samples, 24% were positive (fecal bacteria 86%, fecal fungi 16%, Clostridium difficile 16%; throat bacteria 17% and throat fungi 4%). Enterobacteria and enterococci were the most common fecal findings, staphylococci and streptococci in the throat. Of the bacterial stool samples pretransplant, 74% (mostly enterococci) were resistant to our first-line antibiotics (ceftazidime and cloxacillin). Candida species accounted for the majority of the fungal findings: 62% of the fecal and 78% in the throat. A total of 170 clinical infection episodes were recorded, and in 12 of these, the bacterial blood culture was positive. In 4/12 cases, the pathogen was detected in surveillance culture previously, leading to sensitivity and specificity of 33.3 and 47.4%, respectively. Positive predictive value of bacterial surveillance cultures was 0.9%. The antimicrobial treatment was changed in only five cases based on the surveillance culture results. Weekly surveillance cultures seldom provided clinical benefit and were not cost-effective.
authors.affiliation: Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Suvi-Tuuli
authors.initials: ST
authors.lastname: Simojoki
authors.forename: Vesa
authors.initials: V
authors.lastname: Kirjavainen
authors.forename: Jaana
authors.initials: J
authors.lastname: Rahiala
authors.forename: Jukka
authors.initials: J
authors.lastname: Kanerva
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000150:complications / Q000628:therapy; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000382:microbiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D000890:Anti-Infective Agents
keywords: allogeneic hematopoietic stem cell transplantation; pediatric; surveillance cultures