Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

Salamonowicz, Małgorzata; Ociepa, Tomasz; Frączkiewicz, Jowita; Szmydki‐Baran, Anna; Matysiak, Michał; Czyżewski, K; Wysocki, Mariusz; Gałązka, Przemysław; Zalas‐Więcek, Patrycja; Irga‐Jaworska, Ninela; Drożyńska, Elżbieta; Zając‐Spychała, Olga; Wachowiak, Jacek; Gryniewicz–Kwiatkowska, Olga; Czajńska‐Deptuła, Aneta; Dembowska-Bagińska, Bożena; Chełmecka‐Wiktorczyk, Liliana; Balwierz, Walentyna; Bartnik, Magdalena; Zielezińska, Karolina; Urasiński, Tomasz; Tomaszewska, Renata; Szczepański, Tomasz; Płonowski, Marcin; Krawczuk‐Rybak, Maryna; Pierlejewski, Filip; Młynarski, Wojciech; Gamrot‐Pyka, Zuzanna; Woszczyk, Mariola; Małas, Zofia; Badowska, Wanda; Urbanek‐Dądela, Agnieszka; Karolczyk, Grażyna; Stolpa, Weronika; Sobol‐Milejska, Grażyna; Zaucha‐Prażmo, Agnieszka; Kowalczyk, Jerzy; Goździk, Jolanta; Gorczyńska, Ewa; Jermakow, Katarzyna; Król, Anna; Chybicka, Alicja; Ussowicz, Marek; Kałwak, Krzysztof; Styczyński, Jan

doi:10.1007/s10096-018-3316-5

Cited by 24 publications

(37 citation statements)

References 41 publications

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“…First, the incidence of AdVI among cancer patients concerns all malignancy types, not only acute leukemias. Even though our findings are similar to the other ones, which have shown that the frequency of AdVIs is low and outcomes are favorable for children with acute leukemia in general, patients with STs are also at risk of this type of infection 2,4,10,11 . Second, in comparison to cancer patients, the incidence of AdVIs in HSCT recipients, especially from MD and MMUD donors, is much higher and this cohort should be regularly screened and monitored for HAdV as a basis for preemptive treatment in the early posttransplantation period.…”

Section: Discussionsupporting

confidence: 80%

Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study

Zając‐Spychała

Pieczonka

Wachowiak

et al. 2020

Journal of Medical Virology

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The aim was to evaluate the incidence, clinical course, and outcome of adenoviral infection (AdVI) in pediatric patients diagnosed and treated due to cancer and in pediatric recipients of hematopoietic stem cell. Over a 72‐month period, all‐in 5599 children with cancer: 2441 patients with hematological malignancy (HM) and 3158 with solid tumors (ST), and 971 patients after transplantation: 741 after allogeneic (allo‐HSCT) and 230 after autologous (auto‐HSCT) were enrolled into the study. Among cancer patients, 67 episodes of AdVI appeared in 63 (1.1%) children, including 45 (1.8%) with HM and 18 (0.6%; P < .001) with ST. Within transplanted patients, AdVIs were responsible for 88 episodes in 81 (8.3%) children (P < .001), including 78 (10.5%) patients after allo‐HSCT and 3 (1.3%) after auto‐HSCT. Time to develop AdVI was short, especially after allo‐HSCT. The most common clinical manifestation in cancer patients was enteritis diagnosed in 63 (94.0%) cases, while among HSCT recipient asymptomatic adenoviremia was found in 36 (40.9%) cases and the most common clinical manifestation was urinary tract infection. Cancer patients with disseminated disease, as well as HSCT recipients with either asymptomatic viremia or disseminated disease, received antiviral treatment. The most commonly used first‐line therapy was cidofovir. None of the cancer patients died due to AdVI, while within HSCT recipients three patients developed disseminated adenoviral disease and died despite antiviral treatment. In cancer patients, AdVIs are rare and associated with very good prognosis even without specific treatment. However, in allo‐HSCT recipients, disseminated disease with fatal outcome is more likely to occur.

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Section: Discussionsupporting

confidence: 80%

Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study

Zając‐Spychała

Pieczonka

Wachowiak

et al. 2020

Journal of Medical Virology

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“…Second most common Gram‐positive pathogen found in our patients was Clostridium difficile (CD). Higher rate of CD infection in lymphoma pediatric patients can occur due to a higher incidence of the main risk factors related to this infection such as prolonged hospitalization, gastrointestinal mucosa damage due to chemotherapy, radiotherapy, frequent use of antibiotics, and also development of gastrointestinal GVHD in transplanted patients 19 …”

Section: Discussionmentioning

confidence: 99%

Hematopoietic stem cell transplantation does not increase the risk of infection‐related complications for pediatric patients with Hodgkin and non‐Hodgkin lymphomas: A multicenter nationwide study

Zając‐Spychała

Wachowiak

Czyżewski

et al. 2020

Transplant Infectious Dis

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Background Hodgkin (HL) and non‐Hodgkin lymphoma (NHL) represent a spectrum of lymphoid malignancies that are often curable with currently applied treatment regimens; however, 15%‐30% of lymphoma patients still suffer from relapsed or refractory (rel/ref) disease. Although hematopoietic stem cell transplantation (HSCT) improves outcomes of second‐line therapy for lymphoma in childhood, the complication rates in this group of patients, especially infectious complications (IC), remain unclear. Objective The aim of this population‐based cohort study was a retrospective analysis of incidence, epidemiology and profile of bacterial infections (BI), invasive fungal disease (IFD), and viral infections (VI) in primary or rel/ref lymphoma patients, both HL and NHL. Patients and methods We subdivided lymphoma patients into three groups: patients with primary conventional chemotherapy/radiotherapy regimens (group A), patients with rel/ref lymphoma treated with second‐line chemotherapy (group B), and rel/ref lymphoma patients who underwent HSCT (group C). The medical records of the patients were biannually reported by each pediatric oncology center, and the data were analyzed centrally. Results Within 637 patients with primary lymphoma, at least one IC was diagnosed in 255 (40.0%), among 52 patients with rel/ref lymphoma 24 (46.2%) ICs were observed, and in transplanted group, 28 (57.1%) out of 49 children were diagnosed with IC (P = .151). The distribution of etiology of IC differed between the patient groups (A, B, C), with a predominance of BI in group A (85.6% vs 72.0% and 47.9%, respectively), VI in group C (9% and 16.0% vs 46.6%, respectively), and IFD in group B (5.4% vs 12.0% vs 5.5%, respectively). Overall, 500 (68.0%) episodes of bacterial IC were diagnosed in the entire group. Apart from HL patients treated with chemotherapy, in all the other subgroups of patients Gram‐positives were predominant. The rate of multidrug‐resistant bacteria was high, especially for Gram‐negatives (41.1% in group A, 62.5% in group B, and 84.6% in group C). The infection‐related mortality was comparable for each group. Conclusions The incidence of IC was comparable during first‐ and second‐line chemotherapy and after HSCT, but their profile was different for primary or re/ref lymphoma and depended on the type of therapy.

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“…CDI incidence was highest in patients with hematological malignancies. Most of the patients experienced mild CDI [21].…”

Section: Clostridium Difficile Infectionsmentioning

confidence: 99%

Infectious complications in children and adults with hematological malignancies

Styczyński

2019

Acta Haematologica Polonica

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Infections are the main cause of morbidity and mortality in pediatric hematology and oncology (PHO) and hematopoietic cell transplantation (HCT) settings in children and adults. The analysis of incidence and outcome of bacterial, fungal, and viral infections in Polish PHO/ HCT centers was performed over a period of 72 months (2012–2017). The summary of infections in 5628 patients with newly diagnosed malignancy and 971 HCTs is presented in this paper. Additionally, data of 650 pediatric HCTs from 2012 to 2015 were compared with the data of 3200 HCTs in adults. The risk of any infection per patient was higher in HCT vs PHO patients (2062/971 vs 7115/5628; 2.1 vs 1.3; HR=1.7, p<0.0001). The incidence of bacterial infections was 34,2±0,6% in PHO vs 41,5±1,6% in HCT patients, and the outcome was better in PHO patients: 97,9±0,2% vs 91,8±1,0%. The incidence of patients with fungal infection was 8,8±0,4% vs 21,2±1,3%, and the outcome was better in PHO patients: 95,9±0,7% vs 85,8±2,3%. Incidence of viral infections was 5,0±1,0% in PHO setting, including part of previously transplanted patients, and 47,8±2,2% in HCT setting (60,9±2,3% allo-HCT; 5,6±1,3% auto-HCT). In children, the incidence was higher for bacterial (36.0% vs 27.6%), fungal (25.3% vs 6.3%), and viral (56.3% vs 29.3% allo-HCT; 6.6% vs 0.8% auto-HCT) infections than in adults (p<0.0001), and the outcome was better for bacterial (95.5% vs 91.4%), fungal (88.0% vs 74.9%), and viral (98.6% vs 92.3%) infections. In conclusion, the presented large studies have determined the incidence of infectious complications and their outcomes in HCT and PHO centers in Poland.

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Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation

Cited by 24 publications

References 41 publications

Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study

Adenovirus infection among pediatric patients with cancer and in pediatric recipients of hematopoietic stem cell: A multicenter nationwide study

Hematopoietic stem cell transplantation does not increase the risk of infection‐related complications for pediatric patients with Hodgkin and non‐Hodgkin lymphomas: A multicenter nationwide study

Infectious complications in children and adults with hematological malignancies

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