Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study.
This nationwide multicentre study analysed the epidemiology of bacterial, viral and fungal infections in paediatric haematopoietic stem cell transplantation (HSCT) and paediatric haematology and oncology (PHO) patients over a period of 24 consecutive months, including incidence, hazard risk and outcome of infections as well as occurrence of multidrug-resistant bacteria. During this period, 308 HSCTs were performed and 1768 children were newly diagnosed for malignancy. Compared to PHO, the risk in HSCT patients was significantly higher for all infections (hazard ratio (HR) 2.7), bacterial (HR 1.4), fungal (HR 3.5) and viral (HR 15.7) infections. The risk was higher in allo- than auto-HSCT for bacterial (HR 1.4), fungal (HR 3.2) and viral (HR 17.7) infections. The incidence of resistant bacteria was higher in HSCT than in PHO patients for both G-negative (72.5% vs. 59.2%) and G-positive (41.4% vs. 20.5%) strains. Cumulative incidence of bacterial, fungal and viral infections in HSCT patients was 33.9, 22.8 and 38.3%, respectively. Cumulative incidence of viral infections in allo-HSCT was 28.0% for cytomegalovirus, 18.5% for BK virus, 15.5% for Epstein-Barr virus, 9.5% for adenovirus, 2.6% for varicella zoster virus, 0.9% for influenza, 0.9% for human herpesvirus 6 and 0.3% for hepatitis B virus. Survival rates from infections were lower in HSCT than in PHO patients in bacterial (96.0 vs. 98.2%), fungal (75.5 vs. 94.6%) and most viral infections. In conclusion, the risk of any infections and the occurrence of resistant bacterial strains in allo-HSCT patients were higher than in auto-HSCT and PHO patients, while the outcome of infections was better in the PHO setting.
Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland. Electronic address: jstyczynski@cm.umk.pl.
J
J
Styczynski
Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
K
K
Czyzewski
Department of Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
M
M
Wysocki
Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland.
O
O
Gryniewicz-Kwiatkowska
Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland.
A
A
Kolodziejczyk-Gietka
Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland.
M
M
Salamonowicz
Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland.
L
L
Hutnik
Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland.
O
O
Zajac-Spychala
Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland.
A
A
Zaucha-Prazmo
Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland.
L
L
Chelmecka-Wiktorczyk
Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland.
K
K
Siewiera
Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland.
J
J
Fraczkiewicz
Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland.
Z
Z
Malas
Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland.
R
R
Tomaszewska
Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland.
N
N
Irga-Jaworska
Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland.
M
M
Plonowski
Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
T
T
Ociepa
Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland.
F
F
Pierlejewski
Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland.
Z
Z
Gamrot
Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland.
A
A
Urbanek-Dadela
Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, Krakow, Poland.
J
J
Gozdzik
Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland.
W
W
Stolpa
Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland.
B
B
Dembowska-Baginska
Department of Oncology, Children's Memorial Health Institute, Warszawa, Poland.
D
D
Perek
Department of Paediatric Haematology and Oncology, Medical University, Warszawa, Poland.
M
M
Matysiak
Department of Paediatric Oncology, Haematology and Transplantology, University of Medical Sciences, Poznan, Poland.
J
J
Wachowiak
Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, Medical University, Lublin, Poland.
J
J
Kowalczyk
Department of Paediatric Oncology and Haematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland.
W
W
Balwierz
Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland.
K
K
Kalwak
Department of Paediatric Stem Cell Transplantation, Haematology and Oncology, Medical University, Wroclaw, Poland.
A
A
Chybicka
Division of Paediatric Haematology and Oncology, Children Hospital, Olsztyn, Poland.
W
W
Badowska
Department of Paediatric Haematology and Oncology, Silesian Medical University, Zabrze, Poland.
T
T
Szczepanski
Department of Paediatrics, Haematology and Oncology, Medical University, Gdansk, Poland.
E
E
Drozynska
Department of Paediatric Oncology and Haematology, Medical University, Bialystok, Poland.
M
M
Krawczuk-Rybak
Department of Paediatric Haematology and Oncology, Pomeranian Medical University, Szczecin, Poland.
T
T
Urasinski
Department of Paediatric Oncology, Haematology and Diabetology, Medical University, Lodz, Poland.
W
W
Mlynarski
Division of Paediatric Haematology and Oncology, Chorzow Paediatric and Oncology Center, Chorzow, Poland.
M
M
Woszczyk
Division of Paediatric Haematology and Oncology, Children Hospital, Kielce, Poland.
G
G
Karolczyk
Division of Paediatric Oncology, Haematology and Chemotherapy, Department of Paediatric, Silesian Medical University, Katowice, Poland.
G
G
Sobol-Milejska
Department of Haematology, University of Medical Sciences, Poznan, Poland.
L
L
Gil
D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology
Bacterial infections; children; haematopoietic stem cell transplantation; invasive fungal infections; malignant diseases; paediatric haematology and oncology; viral infections