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Post Transplant Events

Invasive pneumococcal disease in adult hematopoietic stem cell transplant recipients: a decade of prospective population-based surveillance

Bone Marrow Transplantation volume 41, pages 743–747 (2008)Cite this article

Abstract

Prospective population-based surveillance to assess the epidemiology of invasive pneumococcal disease (IPD) in hematopoietic stem cell transplant (HSCT) patients is limited and a comparison to the general population is lacking. By using a population-based Invasive Bacterial Diseases Network surveillance program, we studied the incidence, clinical significance, serotypes and antimicrobial resistance of IPD in a large cohort of adult HSCT patients and the general population. Streptococcus pneumoniae isolates and patient data were collected prospectively from 1995 to 2004. We identified 14 cases of IPD (based on sterile site isolates) in our HSCT population over a 10-year period. This translated to an incidence rate of 347 infections per 100 000 persons per year. This compared to an incidence of 11.5 per 100 000 persons per year in the general population (regression ratio=30.2; 95% confidence interval (CI) 17.8–50.8, P<0.00001). If nonsterile site isolates (respiratory tract) were included, the incidence rate in transplant patients was 446 per 100 000 persons per year. Serotypes 23F and 6B were most common; 100 and 69.2% of isolates were a serotype included in the pneumococcal polysaccharide and conjugate vaccines, respectively. The antimicrobial resistance rates were high, especially for trimethoprim/sulfamethoxazole. HSCT recipients are at significantly greater risk for IPD than the general population. Preventative strategies are necessary.

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References

  1. Engelhard D, Cordonnier C, Shaw PJ, Parkalli T, Guenther C, Martino R et al. Early and late invasive pneumococcal infection following stem cell transplantation: a European bone marrow transplantation survey. Br J Hematol 2002; 117: 444–450.

    Article  Google Scholar 

  2. Kulkarni S, Powles R, Treleaven J, Riley U, Singhal S, Horton C et al. Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants. Blood 2000; 95: 3683–3686.

    CAS  Google Scholar 

  3. Youssef S, Rodriguez G, Rolston KV, Champlin RE, Raad II, Safdar A . Streptococcus pneumoniae infections in 47 hematopoietic stem cell transplantation recipients: clinical characteristics of infections and vaccine-breakthrough infections, 1989–2005. Medicine (Baltimore) 2007; 86: 69–77.

    Article  Google Scholar 

  4. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46: 1–24.

    Google Scholar 

  5. Centers for Disease Control and Prevention. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant. MMWR 2000; 49: 1–128.

    Google Scholar 

  6. Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R et al. Vaccination of stem cell transplant recipients: recommendations of the infectious diseases working party of the EBMT. Bone Marrow Transplant 2005; 35: 737–746.

    Article  CAS  Google Scholar 

  7. Gill VJ, Fedorko DP, Witebsky FG . The clinician and the microbiology laboratory In: Mandel GL, Bennett JE, Dolin R (eds). Principles and Practice of Infectious Diseases. Churchill Livingstone: Philadelphia, PA, USA, 2005, pp 203–241.

    Google Scholar 

  8. Musher DM, Alexandraki I, Graviss EA, Yanbeiy N, Eid A, Inderias LA et al. Bacteremic and nonbacteremic pneumococcal pneumonia: a prospective study. Medicine (Baltimore) 2000; 79: 210–221.

    Article  CAS  Google Scholar 

  9. National Committee for Clinical Laboratory Standards (NCCLS). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 5th edn. Approved standard M7-A5 National Committee for Clinical Laboratory Standards. NCCLS: Wayne, PA, 2000.

  10. National Committee for Clinical Laboratory Standards (NCCLS). Performance standards for antimicrobial testing. 13th informational supplement. NCCLS Document M100-S14 NCCLS: Wayne, PA, 2003.

  11. Kumar D, Humar A, Plevneshi A, Green K, Prasad GV, Siegal D et al. Invasive pneumococcal disease in solid organ transplant recipients—10-year prospective population surveillance. Am J Trans 2007; 7: 1209–1214.

    Article  CAS  Google Scholar 

  12. Metlay JP, Hofmann J, Cetron MS, Fine MJ, Farley MM, Whitney C et al. Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2000; 30: 520–528.

    Article  CAS  PubMed  Google Scholar 

  13. Yu VL, Chiou CC, Feldman C, Ortqvist A, Rello J, Morris AJ et al. An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 2003; 37: 230–237.

    Article  CAS  PubMed  Google Scholar 

  14. Castagnola E, Fioredda F . Prevention of life-threatening infections due to encapsulated bacteria in children hyposplenia or asplenia: a brief review of current recommendations for practical purposes. Eur J Haematol 2003; 71: 319–326.

    Article  PubMed  Google Scholar 

  15. Tauro S, Dobie D, Richardson G, Hastings M, Mahendra P . Recurrent penicillin-resistant pneumococcal sepsis after matched unrelated donor (MUD) transplantation for refractory T cell lymphoma. Bone Marrow Transplant 2000; 26: 1017–1019.

    Article  CAS  PubMed  Google Scholar 

  16. Henning KJ, White MH, Sepkowitz KA, Armstrong D . A national survey of immunization practices following allogeneic bone marrow transplantation. JAMA 1997; 277: 1148–1151.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Collaborating investigators in the Toronto Invasive Bacterial Disease Network are as follows: P Da Camara and J Downey, Toronto East General Hospital (Toronto, Canada); HR Devlin, St Michael's Hospital (Toronto); H Dick, Vita-Tech Laboratories (Toronto); IN Gaid and I Kitai, Rouge Valley Health System (Toronto); P Garrod and N Rau, Halton Healthcare Services (Oakville, Canada); R Lovinsky, D Noria, D Rose and J Braithwaite, The Scarborough Hospital (Toronto); F Jamieson, Ontario Public Health Laboratory (Toronto); R Grossman, Credit Valley Hospital (Mississauga, Canada); J Kapala, Gamma Dynacare Laboratories (Toronto); S Krajden, St Joseph's Health Centre (Toronto); KS Lee and M Baqi, Humber River Regional Hospital (Toronto); M Loeb and F Smaill, Hamilton Health Sciences Center (Hamilton, Canada); M Lovgren and G Tyrrell, National Centre for Streptococcus (Edmonton, Canada); AG Matlow, Hospital for Sick Children (Toronto); R McKeown, Peel Region Health Department (Brampton, Canada); B Mederski and K Katz, North York General Hospital (North York, Canada); Z Moloo, D Richardson and C Quan, William Osler Health Care Centre (Brampton); M Naus, British Columbia Centers for Disease Control (Vancouver, Canada); K Ostrowska and A Sarabia, Trillium Health Centre (Mississauga); P Shokry and I Ephtimios, Markham Stouffville Hospital (Markham, Canada); AE Simor and M Vearncombe, Sunnybrook and Women's College Health Science Centre (Toronto); D Sturman, Bridgepoint Hospital (Toronto); P Van Nostrand, The Rehabilitation Institute of Toronto (Toronto); S Walmsley, University Health Network (Toronto); D Low, B Willey and S Pong-Porter, Toronto Medical Labs/Mount Sinai Hospital (Toronto); B Yaffe, City of Toronto Public Health (Toronto); D Yamamura, MDS Laboratories (Toronto); M Silverman, Lakeridge Health (Oshawa, Canada); R Robertson, Royal Victoria Hospital (Barrie, Canada) and G Volkening, Southlake Regional Health Center (Newmarket, Canada).

Dr Kumar had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Author notes

  1. Members of the Toronto Invasive Bacterial Diseases Network are listed within Acknowledgements.

Authors and Affiliations

  1. Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada

    D Kumar & A Humar

  2. Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada

    A Plevneshi, K Green & A McGeer

  3. Department of Medicine, Queen's University, Kingston, Ontario, Canada

    D Siegal

  4. Department of Hematology, University of Toronto, Toronto, Ontario, Canada

    N Franke

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  1. D Kumar
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  2. A Humar
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  3. A Plevneshi
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  4. D Siegal
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  5. N Franke
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  6. K Green
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  7. A McGeer
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The Toronto Invasive Bacterial Diseases Network

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Correspondence to D Kumar.

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No author has a conflict of interest relevant to this article.

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Kumar, D., Humar, A., Plevneshi, A. et al. Invasive pneumococcal disease in adult hematopoietic stem cell transplant recipients: a decade of prospective population-based surveillance. Bone Marrow Transplant 41, 743–747 (2008). https://doi.org/10.1038/sj.bmt.1705964

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