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, Corrado
AU - Bertaina, Alice
AU - Piciocchi, Alfonso
AU - Perruccio, Katia
AU - Algarotti, Alessandra
AU - Busca, Alessandro
AU - Cattaneo, Chiara
AU - Raiola, Anna Maria
AU - Guidi, Stefano
AU - Iori, Anna Paola
AU - Candoni, Anna
AU - Irrera, Giuseppe
AU - Milone, Giuseppe
AU - Marcacci, Giampaolo
AU - Scimè, Rosanna
AU - Musso, Maurizio
AU - Cudillo, Laura
AU - Sica, Simona
AU - Castagna, Luca
AU - Corradini, Paolo
AU - Marchesi, Francesco
AU - Pastore, Domenico
AU - Alessandrino, Emilio Paolo
AU - Annaloro, Claudio
AU - Ciceri, Fabio
AU - Santarone, Stella
AU - Nassi, Luca
AU - Farina, Claudio
AU - Viscoli, Claudio
AU - Rossolini, Gian Maria
AU - Bonifazi, Francesca
AU - Rambaldi, Alessandro
AU - (AMCLI), Gruppo Italiano Trapianto di Midollo Osseo (GITMO)
AU - Italiani, Associazione Microbiologi Clinici
PY - 2017/11/13
Y1 - 2017/11/13
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 - Journal Article
U2 - 10.1093/cid/cix690
DO - 10.1093/cid/cix690
M3 - Article
VL - 65
SP - 1884
EP - 1896
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 11
ER -