Analysis of early infectious complications in pediatric patients undergoing bone marrow transplantation

The purpose of the present study was to analyze the characteristics of infe ctious complications occurring during the first 100 days after bone marrow transplantation (BMT) in a cohort of 123 pediatric patients with hematologi cal malignancies (n = 73), solid tumors (n = 32) and nonmalignant disorders (n = 18). Fifty-eight patients received allogeneic grafts, and 65 patients an autologous transplant. Fever developed in 107 (87%) children; 82% of in fectious complications occurred during the neutropenic period. Documented i nfection developed in 33 (31%) patients, while 74 (69%) patients had possib le infection (i.e. fewer of unknown origin). The incidence of bacteremia wa s 21%, and gram-positive cocci were the predominant pathogens; non-bacterem ic microbiologically documented infection developed in 6% of patients; clin ically evident infection developed in 4% of subjects. The incidence of prim ary febrile episodes was not significantly different between autologous and allogeneic BMT (86% vs 88%); nor did the median number of days to the onse t of fever (5 days in both groups) or the median duration of fever (5 days in both groups) differ. In contrast, the frequency of secondary febrile epi sodes was significantly higher (P = 0.0001) in allogeneic BMT recipients (4 0%) than in autologous recipients (15%). The mortality rate due to infectio ns was 2/36 (5%) for matched sibling donor BMT, and 1/13 (8%) for matched u nrelated donor BMT. No deaths occurred in the 65 patients who were autograf ted. Invasive fungal infections accounted for 2 of the 3 infectious deaths. In conclusion, the majority of children undergoing BMT experienced at leas t one infectious episode; allogeneic BMT recipients were at high risk of de veloping secondary febrile episodes, but the overall mortality rate due to infection in the first 100 days after transplantation was low.