title: Role of acute graft-versus-host disease in the risk of bacteremia and invasive fungal disease after allogeneic hemopoietic stem cell transplantation in children. Results from a single-center observational study.
abstract: Data on epidemiology of severe infectious complications, ie, bacteremia or invasive fungal disease (IFD), in children with acute graft-versus-host disease (aGVHD) after allogeneic hemopoietic stem cell transplantation (HSCT) are scarce. In a retrospective, single-center study, we analyzed the risk (hazard ratio [HR]) and the rate (episodes/1000 patients days at risk) of bacteremias and IFD in children receiving allogeneic HSCT, according to the type of donor (matched related [MRD] or alternative [AD]) and presence and grade of aGVHD. From 2000 to 2009, 198 children receiving 217 allogeneic HSCT developed 134 severe infectious episodes (103 bacteremias and 31 IFD). The type of donor (AD versus MRD) was the most important risk factor for the severe infections (P = .0052). In separate multivariable analysis for bacteremia and IFD, children receiving an AD HSCT had increased HR and rate of bacteremia compared with those receiving a MRD transplantation (P = .0171 and P = .0001, respectively), whereas the HR and the rate of IFD were significantly influenced by the grade of aGVHD (P = .0002 and P < .0001, respectively). Finally, infectious episodes occurred late after HSCT, especially in presence of severe aGVHD, and bacteremias were 3 to 6 times more frequent than IFD. These data may be important to design management strategies of infections in pediatric allogeneic HSCT.
authors.affiliation: Infectious Disease Unit, Istituto Giannina Gaslini, Genoa, Italy. Electronic address: eliocastagnola@ospedale-gaslini.ge.it.
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.affiliation: Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bagnasco
authors.affiliation: Laboratory Analysis, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bandettini
authors.affiliation: Infectious Disease Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caviglia
authors.affiliation: HSCT Unit - Department of Haematology-Oncology, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morreale
authors.affiliation: HSCT Unit - Department of Haematology-Oncology, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
authors.affiliation: HSCT Unit - Department of Haematology-Oncology, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giardino
authors.affiliation: Infectious Disease Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Moroni
authors.affiliation: Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.affiliation: HSCT Unit - Department of Haematology-Oncology, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
mesh_terms: D000208:Acute Disease; D016470:Bacteremia / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000382:microbiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D009181:Mycoses / Q000276:immunology*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014184:Transplantation, Homologous
keywords: Acute graft-versus-host disease; Allogeneic hemopoietic stem cell transplantation; Bacteremia; Children; Invasive fungal disease