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[Infections after bone marrow transplantation in childhood]
Abstract:
In 66 children having undergone bone marrow transplantation (BMT) the occurrence of infections was studied retrospectively. Bacterial infections were mostly found in the early period after transplantation before marrow engraftment. The analysis of positive blood cultures showed a dominance of gram-positive bacteria, especially of coagulase-negative staphylococci. Cytomegalovirus (CMV) infections were most important, because of its high rate and the risk of CMV associated interstitial pneumonia (IP), two patients suffered from. Infections from herpes simplex virus (HSV), varizella zoster virus (VZV) and Epstein Barr virus (EBV) had no influence on prognosis. In fungal infections the systemic aspergillosis was the most important complication. To increase the effectiveness and safety of therapy the serum levels of antibiotics and antifungal drugs should be determined.
Insights
This retrospective study of 66 children after bone marrow transplantation found bacterial infections common early on, with gram-positive bacteria dominating. Cytomegalovirus infections posed the most significant risk, highlighting the need for monitoring drug levels.
Area of Science:
- Pediatric Hematology Oncology
- Infectious Diseases
- Transplantation Immunology
Context:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric hematologic malignancies and other conditions.
- Post-BMT patients are highly susceptible to infections due to immunosuppression.
- Understanding infection patterns is crucial for improving outcomes in pediatric BMT.
Purpose:
- To retrospectively analyze the incidence and types of infections in children following bone marrow transplantation.
- To identify the most common bacterial, viral, and fungal pathogens encountered post-BMT.
- To assess the impact of specific infections on patient prognosis and complications.
Summary:
- Bacterial infections were most prevalent in the early post-transplant period before marrow engraftment.
- Gram-positive bacteria, particularly coagulase-negative staphylococci, dominated positive blood cultures.
- Cytomegalovirus (CMV) infections were significant due to high incidence and association with CMV-associated interstitial pneumonia (IP).
- Fungal infections, notably systemic aspergillosis, represented a major complication.
- Herpes simplex virus (HSV), varicella zoster virus (VZV), and Epstein Barr virus (EBV) infections did not significantly affect prognosis.
Impact:
- Findings underscore the importance of vigilant monitoring for bacterial and viral infections in the early post-BMT phase.
- Highlights Cytomegalovirus (CMV) as a critical pathogen requiring specific attention and management strategies.
- Suggests that therapeutic drug monitoring of antibiotic and antifungal serum levels can enhance treatment efficacy and safety.