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Respiratory pathogens associated with intubated pediatric patients following hematopoietic cell transplant
Shira J Gertz1, Jennifer McArthur2,3, Deyin D Hsing4
1Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Insights
Respiratory pathogens in pediatric hematopoietic cell transplant (HCT) recipients with respiratory failure were identified. The presence of any pathogen increased mortality and prolonged ventilation, suggesting early detection is crucial.
Area of Science:
- Pediatric critical care medicine
- Hematopoietic cell transplantation
- Infectious diseases
Background:
- Respiratory failure is a serious complication in pediatric hematopoietic cell transplant (HCT) recipients.
- Identifying respiratory pathogens is crucial for managing these vulnerable patients.
Purpose of the Study:
- To describe the spectrum of respiratory organisms found in pediatric HCT recipients with respiratory failure.
- To assess the impact of these pathogens on clinical outcomes.
Main Methods:
- Retrospective analysis of a multicenter cohort of 222 pediatric HCT recipients requiring mechanical ventilation.
- Recording of positive respiratory pathogens and method of sample collection.
- Statistical analysis using Mann-Whitney U test and chi-squared analysis to compare outcomes.
Main Results:
- 34.6% of patients had a positive respiratory culture, with viral pathogens being the most common (48.6%).
- Presence of a respiratory pathogen was associated with increased PICU mortality (68.8% vs 54.9%) and longer ICU stays and mechanical ventilation durations.
- Pathogen type or detection method did not significantly alter outcomes.
Conclusions:
- High variability in identified respiratory pathogens exists in this population.
- The presence of any respiratory organism, regardless of type, is linked to worse outcomes.
- Early detection and treatment of respiratory pathogens may improve outcomes in pediatric HCT recipients.
Background:
We describe organisms found in the respiratory tracts of a multicenter cohort of pediatric hematopoietic cell transplant (HCT) recipients with respiratory failure.
Methods:
Twelve centers contributed up to 25 pediatric allogeneic HCT recipients requiring mechanical ventilation for respiratory failure to a retrospective database. Positive respiratory pathogens and method of obtaining sample were recorded. Outcomes were assessed using Mann-Whitney U test or chi-squared analysis.
Results:
Of the 222 patients in the database, ages 1 month through 21 years, 34.6% had a positive respiratory culture. 105 pathogens were identified in 77 patients; of those, 48.6% were viral, 34.3% bacterial, 16.2% fungal, and 1% parasitic. PICU mortality with a respiratory pathogen was 68.8% compared to 54.9% for those without a respiratory pathogen (P = .045). Those with a positive respiratory pathogen had longer PICU length of stay, 20 days (IQR 14.0, 36.8) vs 15 (IQR 6.5, 32.0), P = .002, and a longer course of mechanical ventilation, 17 days (IQR 10, 29.5) vs 8 (3, 17), P < .0001. Method of pathogen identification, type of pathogen, and the presence of multiple pathogens were not associated with changes in PICU outcomes.
Conclusions:
In this multicenter retrospective cohort of intubated pediatric post-HCT patients, there was high variability in the respiratory pathogens identified. Type of pathogen and method of detection did not affect PICU mortality. The presence of any organism leads to increased PICU mortality, longer PICU stay, and increased duration of mechanical ventilation suggesting that early detection and treatment of pathogens may be beneficial in this population.
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