Surveillance cultures in pediatric allogeneic hematopoietic stem cell transplantation

Authors

  • Suvi-Tuuli Simojoki,

    1. Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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  • Vesa Kirjavainen,

    1. Finnish Red Cross Blood Service, Helsinki, Finland
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  • Jaana Rahiala,

    1. Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
    2. Department of Pediatrics, Porvoo Hospital, Porvoo, Finland
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  • Jukka Kanerva

    Corresponding author
    1. Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
    • Jukka Kanerva, Children's Hospital, Helsinki University Central Hospital, P.O. Box 281, FIN-00029 Helsinki, Finland

      Tel.: +358 50 427 9167

      Fax: +358 94 717 4707

      E-mail: jukka.kanerva@hus.fi

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Abstract

The value of surveillance cultures in predicting systemic infections and in guiding antimicrobial treatment is controversial. We investigated 57 pediatric allo-SCTs between 2007 and 2009. ALL (34), AML (5), and severe aplastic anemia (4) were the largest patient groups. Conditioning was TBI-based in 87% and 54% developed GVHD (21% grade III-IV). Of the 2594 weekly colonization samples, 24% were positive (fecal bacteria 86%, fecal fungi 16%, Clostridium difficile 16%; throat bacteria 17% and throat fungi 4%). Enterobacteria and enterococci were the most common fecal findings, staphylococci and streptococci in the throat. Of the bacterial stool samples pretransplant, 74% (mostly enterococci) were resistant to our first-line antibiotics (ceftazidime and cloxacillin). Candida species accounted for the majority of the fungal findings: 62% of the fecal and 78% in the throat. A total of 170 clinical infection episodes were recorded, and in 12 of these, the bacterial blood culture was positive. In 4/12 cases, the pathogen was detected in surveillance culture previously, leading to sensitivity and specificity of 33.3 and 47.4%, respectively. Positive predictive value of bacterial surveillance cultures was 0.9%. The antimicrobial treatment was changed in only five cases based on the surveillance culture results. Weekly surveillance cultures seldom provided clinical benefit and were not cost-effective.

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