1. Intercontinental study on pre-engraftment and post-engraftment Gram-negative rods bacteremia in hematopoietic stem cell transplantation patients: Risk factors and association with mortality
- Author
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Anna Waszczuk-Gajda, Irene Donnini, Ron Ram, Katia Codeluppi, Tulay Ozcelik, Diana Averbuch, Şahika Zeynep Akı, Dan Engelhard, Galina Klyasova, Simone Cesaro, Malgorzata Mikulska, Cristina Tecchio, Anastasia Pouli, Rodrigo Martino, Catherina Lueck, Rafael de la Cámara, Zafer Gulbas, Peter J. Shaw, Thomas Pabst, Lidia Gil, Simona Iacobelli, Batia Avni, Jennifer Hoek, Emmanuelle Nicolas-Virelizier, Gloria Tridello, Aida Botelho de Sousa, Tracey A. O'Brien, Alexandra Jungova, Hamdi Akan, Tsila Zuckerman, Elisabetta Calore, Per Ljungman, Lucrecia Yaňez San Segundo, Claudio Annaloro, Katia Perruccio, Montserrat Batlle, and Jan Styczyński
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Asia ,Multivariate analysis ,genetic structures ,medicine.medical_treatment ,030106 microbiology ,Fluoroquinolone prophylaxis ,Bacteremia ,Disease ,Hematopoietic stem cell transplantation ,03 medical and health sciences ,0302 clinical medicine ,immune system diseases ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Gram-negative ,Mortality ,Post-engraftment ,Pre-engraftment ,Risk factors ,Stem cell transplantation ,Infection control ,Cumulative incidence ,Europe, Eastern ,Prospective Studies ,030212 general & internal medicine ,610 Medicine & health ,Prospective cohort study ,Aged ,Retrospective Studies ,business.industry ,Australia ,Hematopoietic Stem Cell Transplantation ,bacterial infections and mycoses ,medicine.disease ,Europe ,Settore MED/01 ,surgical procedures, operative ,Infectious Diseases ,Cord blood ,sense organs ,business - Abstract
Objectives: We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. Methods: Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center' fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). Results: The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-alloHSCT), 8.4 (95% CI 7-9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5-7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6-7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4-1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. Conclusions: Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
- Published
- 2020