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Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Hematology".

Deadline for manuscript submissions: closed (20 November 2022) | Viewed by 23639

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Special Issue Editor

Prof. Dr. Simone Cesaro

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Guest Editor

Pediatric Hematology Oncology, Ospedale Donna Bambino, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
Interests: fungal infection; pediatric malignancy; hematopoietic stem cell transplantation; neutropenic patients

Special Issue Information

Dear Colleagues,

Infectious complications are the main causes of treatment-related morbidity and mortality after chemotherapy and stem cell transplantation. The prevention and treatment of these complications require continuous updates to epidemiological data, the introduction of innovative treatments and new drugs and the constant education of health personnel, patients and caregivers. In this Special Issue, we aim to present data regarding epidemiology, prevention and treatment of infectious complications in the setting of pediatric and adult hematological oncological patients. Reviews of literature on rare infectious complications, expert opinion consensus and guidelines are also welcome.

Prof. Dr. Simone Cesaro
Guest Editor

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Keywords

infectious complications
chemotherapy
stem cell transplantation
aspergillus infections
zygomycoses
candida infection
adenovirus
citomegalovirus
Epstein-Barr virus
HHV-6 infection
clostridium difficile infection
gram negative infection
gram positive infection
mycobacterial infection
BKV infection
sepsis
infection mortality

Published Papers (12 papers)

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Research

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8 pages, 1451 KiB

Open AccessArticle

Combination of Interleukin-6, C-Reactive Protein and Procalcitonin Values as Predictive Index of Sepsis in Course of Fever Episode in Adult Haematological Patients: Observational and Statistical Study

by Daniela Carcò, Paolo Castorina, Paola Guardo, Valeria Iachelli, Tecla Pace, Paola Scirè, Rosaria Stanco, Uros Markovic, Giulio Antonio Milone, Federica Galbo, Gaetano Moschetti and Emanuele Martorana

J. Clin. Med. 2022, 11(22), 6800; https://doi.org/10.3390/jcm11226800 - 17 Nov 2022

Cited by 3 | Viewed by 1193

Abstract

Haematological patients represent a vulnerable population to opportunistic infections, mainly due to the disease itself and chemotherapy-induced neutropenia. The level of immune suppression strongly increases the importance of timely antibiotic treatment in order to prevent sepsis-related mortality. During the initial fever episode, serum biomarkers are usually used to estimate the probability of blood stream infection prior to the results of microbial diagnosis. A new serum biomarker combination study on a febrile haematological population, including C-reactive protein (CRP), interleukin-6 (IL−6) and procalcitonin (PCT), is proposed in order to improve their predictive accuracy. In our prospective study, CRP, IL−6 and PCT were evaluated in 34 immunosuppressed haematological patients immediately after the onset of 51 fever episodes, either during the course of standard chemotherapy or high-dose chemotherapy and autologous stem cell transplant. The fever episodes were divided into documented infections and fever alone. Receiver operating characteristic analysis (ROC) was performed for each biomarker and a combination of all three biomarkers (multiROC) to define a new predictive index. Significant differences were evidenced between the two groups (documented infection and no infection) for both PCT and IL−6 (p = 0.03 and p = 0.035, respectively), but none for CRP (p = 0.1). The composite parameter is more reliable than any single biomarker alone, with an area under the curve (AUC) of 79% and with high sensitivity and specificity. IL−6 gave the closest response compared to the composite index. Composite parameters of serum biomarkers could be used for an early diagnosis of infection at fever onset in haematological patients. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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11 pages, 267 KiB

Open AccessArticle

Platelet-Derived Biomarkers: Potential Role in Early Pediatric Serious Bacterial Infection and Sepsis Diagnostics

by Aiste Pociute, Muhammed Fazil Kottilingal Farook, Algirdas Dagys, Rimantas Kevalas, Goda Laucaityte and Lina Jankauskaite

J. Clin. Med. 2022, 11(21), 6475; https://doi.org/10.3390/jcm11216475 - 31 Oct 2022

Cited by 5 | Viewed by 1667

Abstract

Fever is the most common complaint of children who are attending a pediatric emergency department (PED). Most of the fever cases are of viral origin; however, the most common markers, such as leucocyte, neutrophil count, or C-reactive protein, are not sensitive or specific enough to distinguish the etiology of fever, especially if children present at the early phase of infection. Currently, platelets have been attributed a role as important sentinels in viral and bacterial infection pathogenesis. Thus, our aim was to analyze different platelet indices, such as PNLR (platelet-to-neutrophil/lymphocyte ratio), PNR (platelet-to-neutrophil ratio) as well as specific secreted proteins, such as sP-selectin, CXCL4, CXCL7, and serotonin. We included 68 children who were referred to PED with the early onset of fever (<12 h). All children with comorbidities, older than five years, and psychiatric diseases, who refused to participate were excluded. All the participants were divided into viral, bacterial, or serious bacterial infection (SBI) groups. All the children underwent blood sampling, and an additional sample was collected for protein analysis. Our analysis revealed statistically significant differences between leucocyte, neutrophil, and CRP levels between SBI and other groups. However, leucocyte and neutrophil counts were within the age norms. A higher PNLR value was observed in a bacterial group, PNR-in viral. As we tested CXCL7 and sP-selectin, alone and together those markers were statistically significant to discriminate SBI and sepsis from other causes of infection. Together with tachypnoe and SpO2 < 94%, it improved the prediction value of sepsis as well as SBI. CXCL4 and serotonin did not differ between the groups. Concluding, CXCL7 and sP-selectin showed promising results in early SBI and sepsis diagnosis. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

12 pages, 963 KiB

Open AccessArticle

Risk Factors of Infection in Relapsed/Refractory Multiple Myeloma Patients Treated with Lenalidomide and Dexamethasone (Rd) Regimen: Real-Life Results of a Large Single-Center Study

by Damian Mikulski, Paweł Robak, Wiktoria Ryżewska, Kamila Stańczak, Kacper Kościelny, Joanna Góra-Tybor and Tadeusz Robak

J. Clin. Med. 2022, 11(19), 5908; https://doi.org/10.3390/jcm11195908 - 07 Oct 2022

Cited by 2 | Viewed by 1994

Abstract

Lenalidomide-based regimens are effective treatment options for patients with relapsed/refractory multiple myeloma (RRMM). However, they are associated with an increased risk of infectious complications. This study examines the clinical factors influencing the occurrence of infection in MM patients treated with lenalidomide and dexamethasone (Rd). A retrospective analysis of all patients who received the Rd regimen between 2017 and 2021 at our institution was performed. The study group consisted of 174 patients and the median age was 65 years. Most patients (n = 110, 63.2%) received the Rd treatment in second-line treatment. The majority of patients (64.3%) received bortezomib-based regimens in the first line of treatment. The median progression-free survival was 12.6 (95% CI: 9.5–16.2) months, and the median overall survival was 22.3 (95% CI: 15.9–28.6) months. The overall response rate was 64.1%, 12.7% of patients achieved complete response, and 20.4% had a very good partial response. In multivariate logistic regression analysis, hypoalbuminemia (OR 4.2, 95% CI: 1.6–11.2, p = 0.0039), autologous hematopoietic stem cell transplantation (AHSCT) before Rd (OR 2.6, 95% CI: 1.0–6.7, p = 0.048), and anemia grade ≥3 (OR 5.0, 95% CI: 1.8–14.0, p = 0.002) were independent factors related to the occurrence of infections. In conclusion, in this large cohort of RRMM patients, AHSCT before Rd regimen therapy, hypoalbuminemia, and anemia during treatment were identified as three independent factors influencing the frequency of infections during Rd therapy. Patients with established risk factors may benefit from optimal supportive therapy. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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11 pages, 1228 KiB

Open AccessArticle

The Impact of High CMV Viral Load and Refractory CMV Infection on Pediatric HSCT Recipients with Underlying Non-Malignant Disorder

by Zofia Szmit, Jowita Frączkiewicz, Małgorzata Salamonowicz-Bodzioch, Anna Król, Marek Ussowicz, Monika Mielcarek-Siedziuk, Karolina Liszka, Paweł Marschollek, Ewa Gorczyńska and Krzysztof Kałwak

J. Clin. Med. 2022, 11(17), 5187; https://doi.org/10.3390/jcm11175187 - 01 Sep 2022

Cited by 3 | Viewed by 1461

Abstract

Hematopoietic stem cell transplantation (HSCT) is a curative therapy for an increasing number of nonmalignant indications. Its use is restricted by severe transplant-related complications, including CMV infection; despite various prophylactic and therapeutic strategies, CMV reactivation has remarkable morbidity and mortality. The analysis included 94 children with nonmalignant disorder who underwent allogeneic HSCT in the Department of Pediatric Hematology, Oncology, and Bone Marrow Transplantation in Wrocław during years 2016–2020. Twenty-seven (29%) children presented with CMV infection, including ten (10/27; 37%) with high level CMV viremia (10,000 copies/mL). Six patients experienced subsequent CMV reactivation. The first-line ganciclovir-based (GCV) treatment was insufficient in 40% (11/27) of children. Overall survival (OS) was significantly lower in children with high CMV viremia compared to those with low levels/no CMV [1yrOS High CMV = 0.80 (95% CI 0.41–0.95) vs. 1yrOS others = 0.96 (95% CI 0.89–0.99)]. Similarly, patients with resistant and recurrent infections had greater risk of death. CMV reactivation at any level relevantly prolonged the hospital stay. CMV reactivation with high viremia load and resistant/recurrent CMV infections lead to a significant decrease in OS in children with nonmalignant disorders treated with HSCT. Our data proves there is an urgent need to introduce an effective anti-CMV prophylaxis in this cohort of patients. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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12 pages, 1091 KiB

Open AccessArticle

Hematocrit Self-Testing in Patients with Polycythemia Vera and Other Hematological Conditions: Assessing the Accuracy of the StatStrip Xpress^® 2 LAC/Hb/Hct Device and User Opinion about the Device in Real-World Clinical Practice

by Alicia Rovó, Claudia Baierlein-Leimbach, Cesare Medri, Ioannis Chanias, Loreen Errass, Theresa Fehr, Therese Triemer, Daphne B. McCarthy-Pontier and Thomas Lehmann

J. Clin. Med. 2022, 11(14), 4234; https://doi.org/10.3390/jcm11144234 - 21 Jul 2022

Viewed by 2012

Abstract

Maintaining hematocrit (Hct) levels below 45% can reduce morbidity and mortality in patients with polycythemia vera (PV). A device that patients can use to self-monitor Hct levels could enable timely interventions if Hct levels increase above 45%, and could improve quality of life (QoL). This study evaluated the accuracy of the StatStrip Xpress^® 2 LAC/Hb/Hct meter (Hb/Hct meter) when used by healthcare professionals (HCPs) or patients in clinical practice. Blood samples from 68 visits for 60 patients with PV or other hematological conditions were collected and analyzed by HCPs using a laboratory hematological analyzer, and by patients (self-test) and HCPs (professional test) using the Hb/Hct meter at two Swiss centers. Accuracy was assessed as the mean difference in readings between two users/methods (mdiff, 90% confidence interval; Spearman correlation [r]). The Hct values were similar between the professional test and analyzer (n = 66 comparisons, mdiff = 0.1% [−0.5 to 0.8]; r = 0.95, p < 0.001), the self-test and professional test (n = 62 comparisons, mdiff = −0.2% [−1.1 to 0.7]; r = 0.93, p < 0.001), and the self-test and analyzer (n = 63 comparisons, mdiff = 0.0% [−0.8 to 0.7]; r = 0.94, p < 0.001). The hemoglobin values across users/methods were also similar. Reporting their opinion on the Hb/Hct meter at visit 1, 100% of the patients found it easy to use, and 97% were willing to use it at home. Of the patients with PV, approximately 71% and 56%, respectively, stated that they would feel safer using a self-testing device, and that it would improve their QoL. These findings demonstrate the potential of the Hb/Hct meter for HCP and patient use in real-world settings. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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11 pages, 764 KiB

Open AccessArticle

Correlation of Body Mass Index and Proinflammatory Cytokine Levels with Hematopoietic Stem Cell Mobilization

by Tso-Fu Wang, Yu-Shan Liou, Hsin-Hou Chang, Shang-Hsien Yang, Chi-Cheng Li, Jen-Hung Wang and Der-Shan Sun

J. Clin. Med. 2022, 11(14), 4169; https://doi.org/10.3390/jcm11144169 - 18 Jul 2022

Cited by 3 | Viewed by 1882

Abstract

This study investigated the correlation of body mass index (BMI) and proinflammatory cytokine levels with hematopoietic stem cell (HSC) mobilization triggered by granulocyte colony-stimulating factor (G-CSF). Stem cell donors (n = 309) were recruited between August 2015 and January 2018 and grouped into four groups according to their BMI: underweight (BMI < 18.5 kg/m², n = 10), normal (18.5 kg/m² ≦ BMI < 25 kg/m², n = 156), overweight (25 kg/m² ≦ BMI < 30 kg/m², n = 102), and obese (BMI ≧ 30 kg/m², n = 41). The participants were then administered with five doses of G-CSF and categorized as good mobilizers (CD34 ≧ 180/μL, n = 15, 4.85%) and poor mobilizers (CD34 ≦ 25/μL, n = 14, 4.53%) according to the number of CD34⁺ cells in their peripheral blood after G-CSF administration. The correlation between BMI and HSC mobilization was then analyzed, and the levels of proinflammatory cytokines in the plasma from good and poor mobilizers were examined by ProcartaPlex Immunoassay. Results showed that BMI was highly correlated with G-CSF-triggered HSC mobilization (R² = 0.056, p < 0.0001). Compared with poor mobilizers, good mobilizers exhibited higher BMI (p < 0.001) and proinflammatory cytokine [interferon gamma (IFN-γ) (p < 0.05), interleukin-22 (IL-22) (p < 0.05), and tumor necrosis factor alpha (TNF-α) levels (p < 0.05)]. This study indicated that BMI and proinflammatory cytokine levels are positively correlated with G-CSF-triggered HSC mobilization. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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13 pages, 1099 KiB

Open AccessArticle

Protozoan Intestinal Parasitic Infection in Patients with Hematological Malignancies

by Aleksandra Łanocha, Natalia Łanocha-Arendarczyk, Dominika Wilczyńska, Barbara Zdziarska and Danuta Kosik-Bogacka

J. Clin. Med. 2022, 11(10), 2847; https://doi.org/10.3390/jcm11102847 - 18 May 2022

Cited by 6 | Viewed by 3866

Abstract

The aim of this study was to evaluate the frequency of gastrointestinal protozoan infection in patients with hematological malignancies (HMs) undergoing intensive hemato-oncological treatment and to determine the influence of certain biological factors on the incidence of intestinal parasite infection. Stool samples were collected from hematological malignancy patients (n = 50) hospitalized at the Department of Hematology and Transplantology of the Pomeranian Medical University in Szczecin. The control group consisted of 50 healthy participants. We used a direct smear examination and a commercial immunoenzymatic test. Intestinal protozoans were detected in 16% of patients with hematological malignancies and in 6% of individuals in the control group. In stool samples from patients with HM, cysts of Giardia intestinalis (2%), oocysts of Cryptosporidium spp. (10%), vacuolar forms of potentially pathogenic Blastocystis spp. (2%), and cysts of nonpathogenic Entamoeba coli (2%) were found. Cryptosporidium spp. and Giardia intestinalis coproantigens were detected in 5 (10%) and 1 (2%) patients with HM, respectively. In three participants from the control group, vacuolar forms of Blastocystis spp. were found. In the patients with HM, a significantly higher prevalence of intestinal parasite infection was found in individuals working in the garden without protective gloves and those in contact with animals. In patients with hematological malignancies, intestinal parasites should be excluded, even during intensive chemotherapy treatment. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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21 pages, 1630 KiB

Open AccessArticle

IL-6 Responsiveness of CD4⁺ and CD8⁺ T Cells after Allogeneic Stem Cell Transplantation Differs between Patients and Is Associated with Previous Acute Graft versus Host Disease and Pretransplant Antithymocyte Globulin Therapy

by Tor Henrik Anderson Tvedt, Stefan Rose-John, Galina Tsykunova, Aymen Bushra Ahmed, Tobias Gedde-Dahl, Elisabeth Ersvær and Øystein Bruserud

J. Clin. Med. 2022, 11(9), 2530; https://doi.org/10.3390/jcm11092530 - 30 Apr 2022

Viewed by 1675

Abstract

Graft-versus-host disease (GVHD), one of the most common and serious complications after allogeneic stem cell transplantation, is mediated by allocative T cells. IL-6 mediates both pro- and anti-inflammatory effects and modulates T cell response through classical signaling and trans-signaling. We investigated the effects on the mTOR and JAK/STAT pathways after various types of IL-6 signaling for circulating T cells were derived from 31 allotransplant recipients 90 days post-transplant. Cells were stimulated with IL-6 alone, hyper-IL-6 (trans-signaling), IL-6+IL-6 receptor (IL-6R; classical + trans-signaling) and IL-6+IL-6R+soluble gp130-Fc (classical signaling), and flow cytometry was used to investigate the effects on phosphorylation of AKT (Thr308), mTOR (Ser2442), STAT3 (Ser727) and STAT3 (Tyr705). CD3⁺CD4⁺ and CD3⁺C8⁺ T cells responded to classical and trans IL-6 stimulation with increased STAT3 (Tyr705) phosphorylation; these responses were generally stronger for CD3⁺CD4⁺ cells. STAT3 (Tyr705) responses were stronger for patients with previous acute GVHD; CD3⁺CD4⁺ cells from GVHD patients showed an additional STAT3 (Ser727) response, whereas patients without acute GVHD showed additional mTOR (Ser2448) responses. Furthermore, treatment with antithymocyte globulin as a part of GVHD prophylaxis was associated with generally weaker STAT3 (Tyr705) responses and altered STAT3 (Ser727) responsiveness of CD3⁺CD4⁺ cells together with increased mTOR (Ser2448) responses for the CD3⁺CD8⁺ cells. Thus, early post-transplant CD3⁺CD4⁺ and CD3⁺ CD8⁺ T cell subsets differ in their IL-6 responsiveness; this responsiveness is modulated by antithymocyte globulin and differs between patients with and without previous acute GVHD. These observations suggest that allotransplant recipients will be heterogeneous with regard to the effects of post-transplant IL-6 targeting. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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15 pages, 290 KiB

Open AccessArticle

Consensus on COVID-19 Vaccination in Pediatric Oncohematological Patients, on Behalf of Infectious Working Group of Italian Association of Pediatric Hematology Oncology

by Simone Cesaro, Paola Muggeo, Daniele Zama, Monica Cellini, Katia Perruccio, Antonella Colombini, Francesca Carraro, Maria Grazia Petris, Valeria Petroni, Maurizio Mascarin, Francesco Baccelli, Elena Soncini, Rosamaria Mura, Milena La Spina, Nunzia Decembrino, Roberta Burnelli, Stefano Frenos, Elio Castagnola, Maura Faraci, Cristina Meazza, Federica Barzaghi, Maria Rosaria D’Amico, Maria Capasso, Elisabetta Calore, Ottavio Ziino, Angelica Barone, Francesca Compagno, Laura Luti, Federica Galaverna, Raffaella De Santis, Letizia Brescia, Linda Meneghello, Angelamaria Petrone, Nagua Giurici, Daniela Onofrillo, Fabian Schumacher and Federico Mercolini Show full author list Hide full author list

J. Clin. Med. 2022, 11(5), 1235; https://doi.org/10.3390/jcm11051235 - 24 Feb 2022

Cited by 7 | Viewed by 1783

Abstract

Vaccines represent the best tool to prevent the severity course and fatal consequences of the pandemic by the new Coronavirus 2019 infection (SARS-CoV-2). Considering the limited data on vaccination of pediatric oncohematological patients, we developed a Consensus document to support the Italian pediatric hematological oncological (AIEOP) centers in a scientifically correct communication with families and patients and to promote vaccination. The topics of the Consensus were: SARS-CoV-2 infection and disease (COVID-19) in the pediatric subjects; COVID-19 vaccines (type, schedule); who and when to vaccinate; contraindications and risk of serious adverse events; rare adverse events; third dose and vaccination after COVID-19; and other general prevention measures. Using the Delphi methodology for Consensus, 21 statements and their corresponding rationale were elaborated and discussed with the representatives of 31 centers, followed by voting. A high grade of Consensus was obtained on topics such as the potential risk of severe COVID-19 outcome in pediatric oncohematological patients, the need for vaccination as a preventative measure, the type, schedule and booster dose of vaccine, the eligibility of the patients for vaccination, and the timing, definition, and management of contraindications and serious adverse events, and other general prevention measures. All 21 of the statements were approved. This consensus document highlights that children and adolescents affected by hematological and oncological diseases are a fragile category. Vaccination plays an important role to prevent COVID-19, to permit the regular administration of chemotherapy or other treatments, to perform control visits and hospital admissions, and to prevent treatment delays. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

Other

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9 pages, 681 KiB

Open AccessOpinion

Consensus Statement on Animals’ Relationship with Pediatric Oncohematological Patients, on Behalf of Infectious Diseases and Nurse Working Groups of the Italian Association of Pediatric Hematology-Oncology

by Giulia Fiumana, Debora Botta, Maria Francesca Dalla Porta, Simone Macchi, Elena Soncini, Antonio Santaniello, Orlando Paciello, Matteo Amicucci, Monica Cellini and Simone Cesaro

J. Clin. Med. 2023, 12(7), 2481; https://doi.org/10.3390/jcm12072481 - 24 Mar 2023

Cited by 2 | Viewed by 1418

Abstract

Contact with animals in pediatric oncohematologic patients is associated with many benefits, but the risk of contracting zoonoses, even if low, must be considered by clinicians. In order to assess the awareness about this topic, we surveyed the Italian pediatric oncohematology centers, which resulted in heterogeneous responses. The Infectious Diseases Working Group and the Nurse Working Group of the Italian Association of Pediatric Hematology-Oncology, together with veterinarians from the National Federation of Italian Veterinarians, drew up a consensus document to unify the indications to be given to families with the aim of guaranteeing a safe interaction between patients and animals and improving the collaboration of clinicians with veterinarians and families. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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12 pages, 473 KiB

Open AccessSystematic Review

Antimicrobial Stewardship Interventions in Pediatric Oncology: A Systematic Review

by Edoardo Muratore, Francesco Baccelli, Davide Leardini, Caterina Campoli, Tamara Belotti, Pierluigi Viale, Arcangelo Prete, Andrea Pession, Riccardo Masetti and Daniele Zama

J. Clin. Med. 2022, 11(15), 4545; https://doi.org/10.3390/jcm11154545 - 04 Aug 2022

Cited by 15 | Viewed by 2051

Abstract

Antimicrobial stewardship programs represent efficacious measures for reducing antibiotic overuse and improving outcomes in different settings. Specific data on pediatric oncology are lacking. We conducted a systematic review on the PubMed and Trip databases according to the PRISMA guidelines, searching for reports regarding antimicrobial stewardship in pediatric oncology and hematology patients. The aim of the study was to summarize the present literature regarding the implementation of antimicrobial stewardship programs or initiatives in this particular population, and provide insights for future investigations. Nine papers were included in the qualitative analysis: three regarding antifungal interventions, five regarding antibacterial interventions, and one regarding both antifungal and antibacterial stewardship interventions. Variable strategies were reported among the included studies. Different parameters were used to evaluate the impact of these interventions, including days of therapy per 1000-patient-days, infections with resistant strains, safety analysis, and costs. We generally observed a reduction in the prescription of broad-spectrum antibiotics and an improved appropriateness, with reduced antibiotic-related side effects and no difference in infection-related mortality. Antibiotic stewardship programs or interventions are effective in reducing antibiotic consumption and improving outcomes in pediatric oncology hematology settings, although stewardship strategies differ substantially in different institutions. A standardized approach needs to be implemented in future studies in order to better elucidate the impact of stewardship programs in this category of patients. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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8 pages, 1434 KiB

Open AccessCase Report

A Disseminated Mycobacterium Abscessus Infection in a Patient Affected by Pulmonary Graft versus Host Disease: Case Report with a Revision of Literature

by Andrea Bernardelli, Alberto Schena, Alessia Savoldi, Chiara Colato, Valentina Baretta, Emiliano D’Alessandro, Giulia Zamboni, Mehrdad Shoushtari Zadeh Naseri, Flavio Favaro, Marta Peracchi, Donatella Schena, Angelo Andreini, Simone Cesaro and Cristina Tecchio

J. Clin. Med. 2022, 11(9), 2410; https://doi.org/10.3390/jcm11092410 - 25 Apr 2022

Cited by 2 | Viewed by 1732

Abstract

Mycobacterium abscessus complex, hereinafter Mab, is a taxonomic group of rapidly growing, nontuberculous mycobacteria (NTM). Despite major advances in understanding virulence, pathogenicity and mechanism of antibiotic resistance, Mab remains a significant cause of pulmonary and extra-pulmonary disease. Herein, we describe a disseminated, macrolide-resistant, Mab subspecies abscessus infection occurring in a severely immune-compromised 34-year-old allotransplanted female patient affected by pulmonary chronic graft versus host disease (cGVHD). The infection was characterized by hematogenous spread, and besides lungs, it involved skin, and soft tissues, resulting in a highly debilitating, painful, and finally fatal disease. Our case describes the severe impact of Mab infections in the setting of allogeneic hematopoietic stem cells transplant (alloHSCT) and related complications. It also highlights the unmet need of preventive and surveillance measures together with the urgency of developing effective vaccines and drugs against emerging NTM. The scarce literature regarding Mab infections in alloHSCT patients is also reviewed. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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