Journal Article

Infections and risk factors for infection-related mortality after pediatric allogeneic hematopoietic stem cell transplantation in Mexico: A single center retrospective study

Del Rocío Loza-Santiaguillo, Paloma, Jiménez-Hernández, Elva, Martínez-Villegas, Octavio, García-Jiménez, Xochiketzalli, Díaz-Padilla, Luis Alejandro, Mejía-Aranguré, Juan Manuel, Montero-Ponce, Inés, Pérez-Casillas, Ruy, Aguilar-Olivares, Dulce María, Delgado-Gaytan, Alejandra Viridiana, Núñez-Villegas, Nora Nancy, García-Jiménez, Mariana, de los Angeles Del Campo-Martínez, María, Ortíz-Fernández, Antonio, Reyes-López, Alfonso, Arellano-Galindo, José, Dueñas-Gonzalez, María Teresa, Tiznado-García, Hector Manuel, Espinosa-Hernández, Laura Eugenia, Jaimes-Reyes, Ethel Zulie, García-Soto, Angel, Marín-Palomares, Teresa, Núñez-Enriquez, Juan Carlos, Fernández-Castillo, Gabriela Jazmin, Herver-Olivares, Annecy Nelly, Reynoso-Arenas, Perla Verónica, Valdez-Garibay, Betzayda, Del Socorro Méndez-Tovar, María, Sánchez-Jara, Berenice, Ortíz-Torres, Guadalupe, Noya-Rodríguez, Mario Alberto

2023

Overview

To identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT). Retrospective cohort study of patients <16 years of age treated in 2010-2019 was conducted. Unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CIs) were estimated using Cox regression. Cumulative incidence was calculated. Data for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85). Frequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Analysis / Antifungal agents / Bacteria / Bacterial diseases / Bacterial infections / Biology and Life Sciences / Bone marrow / Children / Complications / Cytomegalovirus / Demographic aspects / Development and progression / Disease prevention / Drug dosages / Fungal infections / Fungi / Graft rejection / Graft versus host disease / Graft-versus-host reaction / Grafting / Gram-positive bacteria / Health aspects / Health hazards / Health risks / Hematopoietic stem cells / Infection / Medical research / Medicine and Health Sciences / Medicine, Experimental / Methods / Mexico / Mortality / Mortality risk / Neutropenia / Nosocomial infections / Observational studies / Patients / Pediatrics / Peripheral blood / Risk factors / Statistical analysis / Stem cell transplantation / Stem cells / Surgery / Transplantation / Umbilical cord / Viral infections / Virus diseases / Viruses