Antimicrobial use in pediatric hematopoietic stem cell transplantation in China: a retrospective multicenter cohort study.

[BACKGROUND] Hematopoietic stem cell transplantation (HSCT) is integral to the management of pediatric hematologic malignancies and non-malignant disease, but infection is a significant cause of morbidity and mortality. The purpose of this study is to assess the application of antimicrobial agents in pediatric HSCT.

[METHODS] This multicenter retrospective observational cohort study was conducted across 21 hospitals in China. We included pediatric patients who underwent HSCT and received antimicrobial treatment between January 2023 and April 2024. The study collected and analyzed data on patients' disease types, antibiotic use, antifungal drug use, and treatment durations, with subgroup analysis based on age. Statistical analysis was performed using Python 3.13.

[RESULTS] We included a total of 186 patients with 73 patients in the tumor group and 113 patients in the non-tumor group. The most frequent disease in the tumor group was acute lymphoblastic leukemia (37 patients, 50.68%), and the most frequent disease in the non-tumor group was mucopolysaccharidosis (48 patients, 42.48%). The antibiotic piperacillin-tazobactam (136 prescriptions, 63.85%) and antifungal agents fluconazole (118 prescriptions) and voriconazole (72 prescriptions, 36.36%) were the most frequently applied antibiotics and antifungal agents, respectively. In patients receiving antibacterial therapy, the median treatment period was 10 days, and the majority of patients were found to have treatment periods of between 7 and 14 days. This corresponded to a non-significant trend toward longer treatment in school-age children compared with infants (10 vs. 8 days).

[CONCLUSION] In pediatric HSCT recipients, antibacterial and antifungal therapy is predominantly broad-spectrum with moderate durations; school-age children have slightly longer courses without significant differences.