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Abstract：
Non-tuberculous mycobacteria (NTM) infections in hematopoietic stem cell transplantation (HSCT) recipients represent a diagnostic and therapeutic challenge. Here, we aimed to review and analyze current literature on incidence, clinical presentation, and outcome of NTM infection after allogeneic HSCT.
We performed a systematic review and meta-analysis of available literature regarding NTM infection in children and adults receiving allogeneic HSCT.
We identified 56 articles eligible for the analysis. Among 15 studies, describing 15,798 allogeneic HSCT, we estimated a prevalence of 1.26% (95% CI 0.72, 1.93) of NTM after transplant. Analysis of 175 patients with NTM infection showed a median time of diagnosis of 318 days after HSCT, an increased prevalence in adults (82.9%), and a most frequent pulmonary involvement (44%). Comparison between children and adults revealed an earlier post-transplant disease onset (median 130 days vs 287 days) and most frequent non-pulmonary presentation in children. A vast heterogeneity of therapeutic approach reflected the lack of universal recommendations regarding drug combination and duration of therapy. Overall, NTM-related mortality accounted for 33% in this systematic review.
Although rare, NTM infections can complicate post-transplant course with a high mortality rate in children and adults. The lack of prospective studies and guidelines prevents identification of risk factors and therapeutic recommendations.
We performed a systematic review and meta-analysis of available literature regarding NTM infection in children and adults receiving allogeneic HSCT.
We identified 56 articles eligible for the analysis. Among 15 studies, describing 15,798 allogeneic HSCT, we estimated a prevalence of 1.26% (95% CI 0.72, 1.93) of NTM after transplant. Analysis of 175 patients with NTM infection showed a median time of diagnosis of 318 days after HSCT, an increased prevalence in adults (82.9%), and a most frequent pulmonary involvement (44%). Comparison between children and adults revealed an earlier post-transplant disease onset (median 130 days vs 287 days) and most frequent non-pulmonary presentation in children. A vast heterogeneity of therapeutic approach reflected the lack of universal recommendations regarding drug combination and duration of therapy. Overall, NTM-related mortality accounted for 33% in this systematic review.
Although rare, NTM infections can complicate post-transplant course with a high mortality rate in children and adults. The lack of prospective studies and guidelines prevents identification of risk factors and therapeutic recommendations.
摘要：
目的：造血干细胞移植（HSCT）受者的非结核分枝杆菌（NTM）感染代表了诊断和治疗的挑战。这里,我们旨在回顾和分析当前关于发病率的文献，临床表现,同种异体HSCT后NTM感染的结果。
方法：我们对接受同种异体HSCT的儿童和成人NTM感染的现有文献进行了系统评价和荟萃分析。
结果：我们确定了56篇符合分析条件的文章。在15项研究中，描述15,798同种异体HSCT，我们估计移植后NTM的患病率为1.26%(95%CI0.72,1.93).对175例NTM感染患者的分析显示，HSCT后的中位诊断时间为318天，成人患病率增加（82.9%），和最常见的肺部受累(44%)。儿童和成人之间的比较显示，移植后疾病发作较早（中位数130天vs287天），儿童中最常见的非肺部表现。治疗方法的巨大异质性反映了缺乏关于药物组合和治疗持续时间的普遍建议。总的来说,在本系统评价中，NTM相关死亡率占33%。
结论：虽然罕见，NTM感染会使移植后的过程复杂化，儿童和成人的死亡率很高。缺乏前瞻性研究和指南阻碍了风险因素的识别和治疗建议。
方法：我们对接受同种异体HSCT的儿童和成人NTM感染的现有文献进行了系统评价和荟萃分析。
结果：我们确定了56篇符合分析条件的文章。在15项研究中，描述15,798同种异体HSCT，我们估计移植后NTM的患病率为1.26%(95%CI0.72,1.93).对175例NTM感染患者的分析显示，HSCT后的中位诊断时间为318天，成人患病率增加（82.9%），和最常见的肺部受累(44%)。儿童和成人之间的比较显示，移植后疾病发作较早（中位数130天vs287天），儿童中最常见的非肺部表现。治疗方法的巨大异质性反映了缺乏关于药物组合和治疗持续时间的普遍建议。总的来说,在本系统评价中，NTM相关死亡率占33%。
结论：虽然罕见，NTM感染会使移植后的过程复杂化，儿童和成人的死亡率很高。缺乏前瞻性研究和指南阻碍了风险因素的识别和治疗建议。
