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Infectious complications after hematopoietic stem cell transplantation for primary immunodeficiency in children: A
Olga Zając-Spychała1, Agnieszka Zaucha-Prażmo2, Joanna Zawitkowska2
1Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.
Insights
Infectious complications (IC) affect over half of pediatric patients with primary immunodeficiency (PID) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Bacterial infections, particularly Gram-positive strains and multidrug-resistant pathogens, were most common.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Immunology
Background:
- Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a critical treatment for pediatric patients with primary immunodeficiency (PID).
- These immunocompromised patients are at high risk for serious infectious complications (IC), including bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI).
- Understanding the characteristics of these infections is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the characteristics of BI, IFD, and VI in pediatric patients with PID following allo-HSCT.
- To analyze the incidence, localization, and causative agents of infectious complications in this vulnerable population.
Main Methods:
- A nationwide study involving 114 pediatric patients with PID who underwent allo-HSCT.
- Data collection on diagnosed infectious complications (IC), including bacterial, fungal, and viral infections.
- Analysis of infection characteristics based on PID type and HSCT donor type.
Main Results:
- Infectious complications (IC) were diagnosed in 52.6% of patients, with bacterial infections (BI) being the most frequent (46.8%), followed by viral infections (VI) (41.5%) and invasive fungal disease (IFD) (11.7%).
- The most common infection site was the gastrointestinal (GI) tract, regardless of HSCT donor type.
- Gram-positive strains, particularly Staphylococcaceae, predominated in BI. Multidrug-resistant (MDR) pathogens, such as ESBL-producing Enterobacteriaceae, accounted for over half of the episodes.
Conclusions:
- The incidence of IC in pediatric PID-HSCT recipients was not dependent on PID type but was influenced by HSCT donor type.
- Infection localization varied significantly with PID and HSCT donor type.
- Bacterial infections were predominantly caused by Gram-positive strains, with MDR pathogens posing a significant challenge.
Purpose:
The aim of this nationwide study was to evaluate the characteristics of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in pediatric patients with PID after allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Patients And Methods:
In total, 114 HSCT recipients were enrolled into the study. At least one infectious complication (IC) was diagnosed in 60 (52.6%) patients aged 0.1-17.7 years, that is, 59.5% with SCID and 49.4% with non-SCID.
Results:
Among 60 HSCT recipients diagnosed with at least one IC, 188 episodes of infectious complications (EIC) were recorded, that is, 46.8% of BI, 41.5% of VI, and 11.7% of proven/probable IFD. According to PID and HSCT donor type, the incidence of EIC was comparable (P = .679). The localization of infections differed significantly due to PID type (P = .002). After each HSCT donor type, the most common site of infection was GI. Overall, BI caused by Gram-positive strains (59.1%) were prevalent, especially Staphylococcaceae. The multidrug-resistant (MDR) pathogens were diagnosed in 52.3%, especially ESBL + Enterobacteriaceae. The profile of VI was comparable for SCID and non-SCID patients (P = .839). The incidence of IFD was comparable for each PID and HSCT donor type. Survival after infection was 91.5% and was comparable for PID and HSCT donor type.
Conclusions:
The rate of patients diagnosed with IC among pediatric PID-HSCT recipients did not depend on PID type, but rather on HSCT donor type. The localization of IC depended on PID and HSCT donor type. Within bacterial infections, predominated Gram-positive strains and the MDR pathogens were responsible for more than half of EIC.
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