Intercontinental study on pre-engraftment and post-engraftment Gram-negative rods bacteremia in hematopoietic stem cell transplantation patients: Risk factors and association with mortality

Diana Averbuch, Gloria Tridello, Jennifer Hoek, Malgorzata Mikulska, Thomas Pabst, Lucrecia Yaňez San Segundo, Hamdi Akan, Tülay Özçelik, Irene Donnini, Galina Klyasova, Aida Botelho de Sousa, Tsila Zuckerman, Cristina Tecchio, Rafael de la Camara, Sahika Zeynep Aki, Per Ljungman, Zafer Gülbas, Emmanuelle Nicolas-Virelizier, Elisabetta Calore, Katia PerruccioRon Ram, Claudio Annaloro, Rodrigo Martino, Batia Avni, Peter J. Shaw, Alexandra Jungova, Katia Codeluppi, Tracey O'Brien, Anna Waszczuk-Gajda, Montserrat Batlle, Anastasia Pouli, Catherina Lueck, Lidia Gil, Simona Iacobelli, Jan Styczynski, Dan Engelhard, Simone Cesaro

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. Methods: Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). Results: The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7–9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5–7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6–7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4–1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. Conclusions: Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.

Original languageEnglish
JournalJournal of Infection
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Bacteremia
  • Fluoroquinolone prophylaxis
  • Gram-negative
  • Mortality
  • Post-engraftment
  • Pre-engraftment
  • Risk factors
  • Stem cell transplantation

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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