TY - JOUR
T1 - Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey
AU - Girmenia, C.
AU - Bertaina, A.
AU - Piciocchi, A.
AU - Perruccio, K.
AU - Algarotti, A.
AU - Busca, A.
AU - Cattaneo, C.
AU - Raiola, A. M.
AU - Guidi, S.
AU - Iori, A. P.
AU - Candoni, A.
AU - Irrera, G.
AU - Milone, G.
AU - Marcacci, G.
AU - Scime, R.
AU - Musso, M.
AU - Cudillo, L.
AU - Sica, S.
AU - Castagna, L.
AU - Corradini, P.
AU - Marchesi, F.
AU - Pastore, D.
AU - Alessandrino, E. P.
AU - Annaloro, C.
AU - Ciceri, F.
AU - Santarone, S.
AU - Nassi, L.
AU - Farina, C.
AU - Viscoli, C.
AU - Rossolini, G. M.
AU - Bonifazi, F.
AU - Rambaldi, A.
AU - (AMCLI), Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani
N1 - LR: 20171115; JID: 9203213; OTO: NOTNLM; 2017/05/21 00:00 [received]; 2017/08/01 00:00 [accepted]; 2017/10/12 06:00 [pubmed]; 2017/10/12 06:00 [medline]; 2017/10/12 06:00 [entrez]; ppublish
M1 - Journal Article
PY - 2017
Y1 - 2017
N2 - Background: Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. Results: The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P
AB - Background: Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. Results: The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P
KW - Gram negative bacteremia
KW - epidemiology
KW - multidrug resistance
KW - stem cell transplant
KW - survival
M3 - Article
VL - 65
SP - 1884
EP - 1896
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 11
ER -