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Bacterial and fungal infections in children undergoing bone marrow transplantation
1Department of Pediatrics, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel. engelhard@hardassah.org.il
Abstract:
Bacterial and fungal infections in pediatric BMT recipients are major causes of morbidity and mortality, although less than those in the adult BMT population. Early in the post-BMT period, when patients are neutropenic, the predominant pathogens are Gram-negative bacteria, mainly E. coli, K. pneumoniae and P. aeruginosa; Gram-positive bacteria, mainly coagulase-negative staphylococcus, S. viridans and E. faecalis; and fungi, mainly Candida spp. and Aspergillus spp. The emerging resistance of a variety of pathogens is of major concern and limits the use of prophylactic antibiotics. Mortality from invasive fungal infections is much greater than that caused by bacterial pathogens. Many centers are currently using prophylactic fluconazole, which may lead to emergence of infections with C. krusei and T. glabrata. Patients with GvHD are at continuous risk from bacterial and fungal pathogens. Late in the post-BMT period, S. pneumoniae may cause septicemia, meningitis, pneumonia and other respiratory infections. This may occur months or years following transplantation, with a significant mortality rate in patients with chronic GvHD. Development of rapid and reliable diagnostic methods for identifying fungal pathogens and of new therapeutic approaches for treating invasive fungal infections are now our greatest future challenges.
Insights
Pediatric bone marrow transplant (BMT) recipients face significant risks from bacterial and fungal infections, particularly during neutropenia. Addressing emerging pathogen resistance and improving diagnostics for invasive fungal infections are critical challenges.
Area of Science:
- Hematology
- Infectious Diseases
- Pediatric Oncology
Background:
- Bacterial and fungal infections are significant causes of morbidity and mortality in pediatric bone marrow transplant (BMT) recipients.
- Neutropenic patients early post-BMT are susceptible to Gram-negative bacteria, Gram-positive bacteria, and fungi.
- Emerging antimicrobial resistance and the high mortality of invasive fungal infections pose major challenges.
Purpose of the Study:
- To review the spectrum of bacterial and fungal infections in pediatric BMT recipients.
- To highlight the challenges posed by antimicrobial resistance and GvHD.
- To identify future research priorities in diagnostics and therapeutics for invasive fungal infections.
Main Methods:
- Literature review of infections in pediatric BMT recipients.
- Analysis of common pathogens during early and late post-transplant periods.
- Discussion of current prophylactic strategies and their limitations.
Main Results:
- Predominant early pathogens include E. coli, K. pneumoniae, P. aeruginosa, coagulase-negative staphylococcus, S. viridans, E. faecalis, Candida spp., and Aspergillus spp.
- Prophylactic fluconazole use can lead to infections by C. krusei and T. glabrata.
- Late post-BMT infections, such as S. pneumoniae, are associated with chronic GvHD and significant mortality.
Conclusions:
- Invasive fungal infections carry a higher mortality rate than bacterial infections in pediatric BMT patients.
- Graft-versus-host disease (GvHD) increases continuous risk from pathogens.
- Development of rapid fungal diagnostics and novel therapeutics is crucial for improving outcomes.