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, Anna Candoni, Giuseppe Irrera, Giuseppe Milone, Giampaolo Marcacci, Rosanna Scimè, Maurizio Musso, Laura Cudillo, Simona Sica, Luca Castagna, Paolo CorradiniFrancesco Marchesi, Domenico Pastore, Emilio Paolo Alessandrino, Claudio Annaloro, Fabio Ciceri, Stella Santarone, Luca Nassi, Claudio Farina, Claudio Viscoli, Gian Maria Rossolini, Francesca Bonifazi, Alessandro Rambaldi, Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)

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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 - Nov 13 2017

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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

  • Journal Article

Cite this

Girmenia, C., Bertaina, A., Piciocchi, A., Perruccio, K., Algarotti, A., Busca, A., ... 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, Anna; Irrera, Giuseppe; Milone, Giuseppe; Marcacci, Giampaolo; Scimè, Rosanna; Musso, Maurizio; Cudillo, Laura; Sica, Simona; Castagna, Luca; Corradini, Paolo; Marchesi, Francesco; Pastore, Domenico; Alessandrino, Emilio Paolo; Annaloro, Claudio; Ciceri, Fabio; Santarone, Stella; Nassi, Luca; Farina, Claudio; Viscoli, Claudio; Rossolini, Gian Maria; Bonifazi, Francesca; Rambaldi, Alessandro; Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI).

In: Clinical Infectious Diseases, Vol. 65, No. 11, 13.11.2017, p. 1884-1896.

Research output: Contribution to journalArticle

Girmenia, C, Bertaina, A, Piciocchi, A, Perruccio, K, Algarotti, A, Busca, A, Cattaneo, C, Raiola, AM, Guidi, S, Iori, AP, Candoni, A, Irrera, G, Milone, G, Marcacci, G, Scimè, R, Musso, M, Cudillo, L, Sica, S, Castagna, L, Corradini, P, Marchesi, F, Pastore, D, Alessandrino, EP, Annaloro, C, Ciceri, F, Santarone, S, Nassi, L, Farina, C, Viscoli, C, Rossolini, GM, Bonifazi, F, Rambaldi, A & 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, vol. 65, no. 11, pp. 1884-1896. https://doi.org/10.1093/cid/cix690
Girmenia, Corrado ; Bertaina, Alice ; Piciocchi, Alfonso ; Perruccio, Katia ; Algarotti, Alessandra ; Busca, Alessandro ; Cattaneo, Chiara ; Raiola, Anna Maria ; Guidi, Stefano ; Iori, Anna Paola ; Candoni, Anna ; Irrera, Giuseppe ; Milone, Giuseppe ; Marcacci, Giampaolo ; Scimè, Rosanna ; Musso, Maurizio ; Cudillo, Laura ; Sica, Simona ; Castagna, Luca ; Corradini, Paolo ; Marchesi, Francesco ; Pastore, Domenico ; Alessandrino, Emilio Paolo ; Annaloro, Claudio ; Ciceri, Fabio ; Santarone, Stella ; Nassi, Luca ; Farina, Claudio ; Viscoli, Claudio ; Rossolini, Gian Maria ; Bonifazi, Francesca ; Rambaldi, Alessandro ; 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.
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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, 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 - Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)

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 <.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 - Journal Article

U2 - 10.1093/cid/cix690

DO - 10.1093/cid/cix690

M3 - Article

C2 - 29020286

VL - 65

SP - 1884

EP - 1896

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 11

ER -