Infections diagnosed in the first year after pediatric stem cell transplantation
Infections diagnosed in the first year after pediatric stem cell transplantation
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DOI：
10.1097/00006454-200203000-00013
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发表时间：
2002-03-01
影响因子：
3.6
通讯作者：
Martin, PL
中科院分区：
文献类型：
--
作者：
Benjamin, DK;Miller, WC;Martin, PL
背景成人患者移植后第一年内感染的累积发生率已得到充分描述。这种描述是不完整的儿科干细胞移植（SCT）患者。此外，在那些已经感染的患者中，对于一个大的儿科SCT患者队列，感染风险因素的分析还没有得到很好的描述。我们在杜克大学医学中心对SCT后第一年的感染进行了回顾性队列研究。我们记录了移植后第一年的所有感染。我们确定了6类感染的发生率：革兰氏阴性杆菌;革兰氏阳性球菌;酵母菌;曲霉菌;腺病毒;和巨细胞病毒。我们根据移植类型和移植后天数确定发病率。我们还完成了感染儿童中感染类型的危险因素[中性粒细胞减少、移植物抗宿主病（GVHD）和GVHD治疗]的双变量和多变量分析。我们评估了485名儿童的510例移植。移植后第一年有584例感染。在移植后的前30天内，移植类型不能预测感染的发生率或感染类型。30天后，接受非亲缘脐血移植和匹配的非亲缘供体移植的儿童感染的风险比接受自体、匹配的同胞或半相合移植的患者高得多（P < 0.001）。接受非血缘脐血移植或匹配非血缘供体移植的患者发生曲霉菌病（P = 0.002）、念珠菌病（P = 0.005）和腺病毒病（P < 0.0001）的风险较高，但巨细胞病毒感染风险不高（P = 0.18）。在感染者的危险因素分析中，曲霉菌病患者更容易发生严重的GVHD：多变量1年风险比为7.5; 95%可信区间为3.0、18.4。中性粒细胞增多症与革兰氏阴性杆菌感染的相关性比其他类型的感染更强。在该儿科人群中，移植后即刻感染的发生率在移植类型之间没有显著差异。移植类型预测了移植后30天感染发生率的增加，以及传统上与移植人群高死亡率相关的几种微生物感染发生率的增加。
Background. Cumulative incidence of infections in the first year posttransplantation in adult patients has been well-described. Such description is less than complete for pediatric stem cell transplantation (SCT) patients. Further among those patients who have been infected, analysis of risk factors for infection has not been well-described for a large cohort of pediatric SCT patients.Methods. We conducted a retrospective cohort study of infections in the first year after SCT at Duke University Medical Center. We recorded all infections in the first year after transplantation. We determined incidences for 6 categories of infection: Gram-negative rods; Gram-positive cocci; yeast species; Aspergillus sp.; adenovirus; and cytomegalovirus. We determined incidences based on type of transplant and days post transplantation. We also completed bivariable and multivariable analysis of risk factors [neutropenia, graft vs. host disease (GVHD) and GVHD treatment] for infection type among those children who were infected.Results. We evaluated 510 transplants in 485 children. There were 584 infections in the first year after transplantation. During the first 30 days posttransplantation, type of transplantation did not predict incidence of infection or type of infection. After 30 days children who received unrelated cord blood transplant and matched unrelated donor transplant were at much higher risk of infection than were patients who received autologous, matched sibling or haploidentical transplant (P < 0.001). Patients who received unrelated cord blood or matched unrelated donor transplantation were at higher risk of aspergillosis (P = 0.002), candidiasis (P = 0.005) and adenovirus (P < 0.0001) but not cytomegalovirus (P = 0.18). In analysis of risk factors among those infected, patients with aspergillosis were more likely to have severe GVHD: multivariable 1 year risk ratio, 7.5; 95% confidence interval, 3.0,18.4. Neutropenia was more strongly associated with Gram-negative rod infection than any other type of infection.Conclusions. The incidence of infection immediately after transplantation did not differ significantly by type of transplant in this pediatric population. Type of transplant predicted increased incidence of infection 30 days posttransplantation and increased incidence of infection with several organisms traditionally associated with a high mortality rate in the transplant population.