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

Gruppo Italiano Trapianto di Midollo Osseo (GITMO), Associazione Microbiologi Clinici Italiani (AMCLI)

Research output: Contribution to journalArticle

22 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. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
Original languageEnglish
Pages (from-to)1884-1896
Number of pages13
JournalClinical Infectious Diseases
Volume65
Issue number11
DOIs
Publication statusPublished - 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

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Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey. / Gruppo Italiano Trapianto di Midollo Osseo (GITMO); Associazione Microbiologi Clinici Italiani (AMCLI).

In: Clinical Infectious Diseases, Vol. 65, No. 11, 2017, p. 1884-1896.

Research output: Contribution to journalArticle

Gruppo Italiano Trapianto di Midollo Osseo (GITMO) ; 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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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. {\circledC} The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.",
author = "C Girmenia and A Bertaina and A Piciocchi and Katia Perruccio and A Algarotti and Alessandro Busca and Chiara Cattaneo and AM Raiola and Stefano Guidi and Iori, {Anna Paola} and A Candoni and Giuseppe Irrera and Giuseppe Milone and G Marcacci and R Scim{\`e} and M Musso and Laura Cudillo and Simona Sica and L Castagna and P Corradini and F Marchesi and Domenico Pastore and EP Alessandrino and C Annaloro and F Ciceri and S Santarone and Luca Nassi and C Farina and C Viscoli and GM Rossolini and Francesca Bonifazi and A Rambaldi and {Gruppo Italiano Trapianto di Midollo Osseo (GITMO)} and {Associazione Microbiologi Clinici Italiani (AMCLI)}",
year = "2017",
doi = "10.1093/cid/cix690",
language = "English",
volume = "65",
pages = "1884--1896",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
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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: An Italian Prospective Multicenter Survey

AU - Girmenia, C

AU - Bertaina, A

AU - Piciocchi, A

AU - Perruccio, Katia

AU - Algarotti, A

AU - Busca, Alessandro

AU - Cattaneo, Chiara

AU - Raiola, AM

AU - Guidi, Stefano

AU - Iori, Anna Paola

AU - Candoni, A

AU - Irrera, Giuseppe

AU - Milone, Giuseppe

AU - Marcacci, G

AU - Scimè, R

AU - Musso, M

AU - Cudillo, Laura

AU - Sica, Simona

AU - Castagna, L

AU - Corradini, P

AU - Marchesi, F

AU - Pastore, Domenico

AU - Alessandrino, EP

AU - Annaloro, C

AU - Ciceri, F

AU - Santarone, S

AU - Nassi, Luca

AU - Farina, C

AU - Viscoli, C

AU - Rossolini, GM

AU - Bonifazi, Francesca

AU - Rambaldi, A

AU - Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

AU - Associazione Microbiologi Clinici Italiani (AMCLI)

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 <.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. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

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. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

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 -