Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

Corrado Girmenia, Alice Bertaina, Alfonso Piciocchi, Katia Perruccio, Alessandra Algarotti, Alessandro Busca, Chiara Cattaneo, Anna Maria Raiola, Stefano Guidi, Anna Paola Iori, A. Candoni, Giuseppe Irrera, L. Castagna, Paolo Corradini, Emilio Paolo Alessandrino, Claudio Annaloro, Fabio Ciceri, Claudio Viscoli, Gian Maria Rossolini, Alice BertainaAngela Mastronuzzi, Daria Pagliara, Paola Bernaschi, Emanuele Angelucci, G. Marcacci, Cristina Becchimanzi, Daniela Donnarumma, L. Castagna, Roberto Crocchiolo, Erminia Casari, Alberto Mussetti, Fabrizio Ensoli, Piero Marone, Raffaella Greco, Nunzia Decembrino, Marco Zecca, Edoardo Lanino, Maura Faraci, Elio Castagnola, Roberto Bandettini, Rocco Pastano, Simona Sammassimo, Rita Passerini, Nicola Cascavilla, Maria Teresa Labonia, Attilio Olivieri, Daniela Caravelli, Susanna Gallo, Pellegrino Musto, Giuseppe Pietrantuono, for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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 <.001) and auto-HSCT (2.43; 1.22-4.84; P =.01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

Original languageEnglish
Pages (from-to)1884-1896
Number of pages13
JournalClinical Infectious Diseases
Volume65
Issue number11
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Hematopoietic Stem Cell Transplantation
Bacteremia
Incidence
Transplants
Infection
Surveys and Questionnaires
Mortality
Klebsiella pneumoniae
Neutropenia
Gram-Negative Bacteria
Fetal Blood
Pseudomonas aeruginosa
Cause of Death
Lymphoma
Leukemia
Epidemiology
Multivariate Analysis
Logistic Models
History
Clinical Trials

Keywords

  • epidemiology
  • Gram negative bacteremia
  • multidrug resistance
  • stem cell transplant
  • survival

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Girmenia, C., Bertaina, A., Piciocchi, A., Perruccio, K., Algarotti, A., Busca, A., ... for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI) (2017). Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey. Clinical Infectious Diseases, 65(11), 1884-1896. https://doi.org/10.1093/cid/cix690

Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation : An Italian Prospective Multicenter Survey. / Girmenia, Corrado; Bertaina, Alice; Piciocchi, Alfonso; Perruccio, Katia; Algarotti, Alessandra; Busca, Alessandro; Cattaneo, Chiara; Raiola, Anna Maria; Guidi, Stefano; Iori, Anna Paola; Candoni, A.; Irrera, Giuseppe; Castagna, L.; Corradini, Paolo; Alessandrino, Emilio Paolo; Annaloro, Claudio; Ciceri, Fabio; Viscoli, Claudio; Rossolini, Gian Maria; Bertaina, Alice; Mastronuzzi, Angela; Pagliara, Daria; Bernaschi, Paola; Angelucci, Emanuele; Marcacci, G.; Becchimanzi, Cristina; Donnarumma, Daniela; Castagna, L.; Crocchiolo, Roberto; Casari, Erminia; Mussetti, Alberto; Ensoli, Fabrizio; Marone, Piero; Greco, Raffaella; Decembrino, Nunzia; Zecca, Marco; Lanino, Edoardo; Faraci, Maura; Castagnola, Elio; Bandettini, Roberto; Pastano, Rocco; Sammassimo, Simona; Passerini, Rita; Cascavilla, Nicola; Labonia, Maria Teresa; Olivieri, Attilio; Caravelli, Daniela; Gallo, Susanna; Musto, Pellegrino; Pietrantuono, Giuseppe; for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI).

In: Clinical Infectious Diseases, Vol. 65, No. 11, 01.12.2017, p. 1884-1896.

Research output: Contribution to journalArticle

Girmenia, Corrado ; Bertaina, Alice ; Piciocchi, Alfonso ; Perruccio, Katia ; Algarotti, Alessandra ; Busca, Alessandro ; Cattaneo, Chiara ; Raiola, Anna Maria ; Guidi, Stefano ; Iori, Anna Paola ; Candoni, A. ; Irrera, Giuseppe ; Castagna, L. ; Corradini, Paolo ; Alessandrino, Emilio Paolo ; Annaloro, Claudio ; Ciceri, Fabio ; Viscoli, Claudio ; Rossolini, Gian Maria ; Bertaina, Alice ; Mastronuzzi, Angela ; Pagliara, Daria ; Bernaschi, Paola ; Angelucci, Emanuele ; Marcacci, G. ; Becchimanzi, Cristina ; Donnarumma, Daniela ; Castagna, L. ; Crocchiolo, Roberto ; Casari, Erminia ; Mussetti, Alberto ; Ensoli, Fabrizio ; Marone, Piero ; Greco, Raffaella ; Decembrino, Nunzia ; Zecca, Marco ; Lanino, Edoardo ; Faraci, Maura ; Castagnola, Elio ; Bandettini, Roberto ; Pastano, Rocco ; Sammassimo, Simona ; Passerini, Rita ; Cascavilla, Nicola ; Labonia, Maria Teresa ; Olivieri, Attilio ; Caravelli, Daniela ; Gallo, Susanna ; Musto, Pellegrino ; Pietrantuono, Giuseppe ; for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI). / Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation : An Italian Prospective Multicenter Survey. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 11. pp. 1884-1896.
@article{a3a576c61509456494bbf94400550d00,
title = "Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey",
abstract = "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 <.001) and auto-HSCT (2.43; 1.22-4.84; P =.01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.",
keywords = "epidemiology, Gram negative bacteremia, multidrug resistance, stem cell transplant, survival",
author = "Corrado Girmenia and Alice Bertaina and Alfonso Piciocchi and Katia Perruccio and Alessandra Algarotti and Alessandro Busca and Chiara Cattaneo and Raiola, {Anna Maria} and Stefano Guidi and Iori, {Anna Paola} and A. Candoni and Giuseppe Irrera and L. Castagna and Paolo Corradini and Alessandrino, {Emilio Paolo} and Claudio Annaloro and Fabio Ciceri and Claudio Viscoli and Rossolini, {Gian Maria} and Alice Bertaina and Angela Mastronuzzi and Daria Pagliara and Paola Bernaschi and Emanuele Angelucci and G. Marcacci and Cristina Becchimanzi and Daniela Donnarumma and L. Castagna and Roberto Crocchiolo and Erminia Casari and Alberto Mussetti and Fabrizio Ensoli and Piero Marone and Raffaella Greco and Nunzia Decembrino and Marco Zecca and Edoardo Lanino and Maura Faraci and Elio Castagnola and Roberto Bandettini and Rocco Pastano and Simona Sammassimo and Rita Passerini and Nicola Cascavilla and Labonia, {Maria Teresa} and Attilio Olivieri and Daniela Caravelli and Susanna Gallo and Pellegrino Musto and Giuseppe Pietrantuono and {for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)}",
year = "2017",
month = "12",
day = "1",
doi = "10.1093/cid/cix690",
language = "English",
volume = "65",
pages = "1884--1896",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "NLM (Medline)",
number = "11",

}

TY - JOUR

T1 - Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation

T2 - 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, A.

AU - Irrera, Giuseppe

AU - Castagna, L.

AU - Corradini, Paolo

AU - Alessandrino, Emilio Paolo

AU - Annaloro, Claudio

AU - Ciceri, Fabio

AU - Viscoli, Claudio

AU - Rossolini, Gian Maria

AU - Bertaina, Alice

AU - Mastronuzzi, Angela

AU - Pagliara, Daria

AU - Bernaschi, Paola

AU - Angelucci, Emanuele

AU - Marcacci, G.

AU - Becchimanzi, Cristina

AU - Donnarumma, Daniela

AU - Castagna, L.

AU - Crocchiolo, Roberto

AU - Casari, Erminia

AU - Mussetti, Alberto

AU - Ensoli, Fabrizio

AU - Marone, Piero

AU - Greco, Raffaella

AU - Decembrino, Nunzia

AU - Zecca, Marco

AU - Lanino, Edoardo

AU - Faraci, Maura

AU - Castagnola, Elio

AU - Bandettini, Roberto

AU - Pastano, Rocco

AU - Sammassimo, Simona

AU - Passerini, Rita

AU - Cascavilla, Nicola

AU - Labonia, Maria Teresa

AU - Olivieri, Attilio

AU - Caravelli, Daniela

AU - Gallo, Susanna

AU - Musto, Pellegrino

AU - Pietrantuono, Giuseppe

AU - for the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)

PY - 2017/12/1

Y1 - 2017/12/1

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 <.001) and auto-HSCT (2.43; 1.22-4.84; P =.01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

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 <.001) and auto-HSCT (2.43; 1.22-4.84; P =.01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

KW - epidemiology

KW - Gram negative bacteremia

KW - multidrug resistance

KW - stem cell transplant

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85034824465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034824465&partnerID=8YFLogxK

U2 - 10.1093/cid/cix690

DO - 10.1093/cid/cix690

M3 - Article

AN - SCOPUS:85034824465

VL - 65

SP - 1884

EP - 1896

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 11

ER -