Risk Factors and Outcomes of Infections by Multidrug-Resistant Gram-Negative Bacteria in Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

The objective of this study was to determine risk factors and outcomes of infections by multidrug-resistant gram-negative (MDR GN) bacteria in 241 recipients of hematopoietic stem cell transplantation (HSCT). The cumulative incidence of infections was 10.5% (95% CI, 12.0% to 25.8%), with 57% of infections occurring during the period of severe neutropenia (neutrophil count < .1 × 10/L). In multivariate analysis, allogeneic transplant and colonization with MDR GN bacteria at admission to the transplant unit were significantly associated with an increased risk of infection. Although we observed neither transplant-related mortality (TRM) nor deaths due to infections by MDR GN bacteria after autologous transplant, in the allogeneic setting a significant difference was reported in terms of overall survival (OS) and TRM between patients who developed infections and those who did not (1-year OS, 39% versus 68%; 1-year TRM, 42% versus 19%). In multivariate analysis, refractory disease and development of grades III to IV graft-versus-host disease (GVHD) were factors that affected both TRM and OS, whereas occurrence of infections by MDR GN pathogens significantly reduced OS. We conclude that eligibility to allogeneic HSCT in MDR GN bacteria carriers should be carefully evaluated together with all other factors that independently influence outcome (disease status, donor, and GVHD risk).

Allogeneic Hematopoietic Stem Cell Transplantation for the Treatment of Severe Aplastic Anemia Patients with Infection: A Single-Center Retrospective Study

“…As previously described, BSI after HSCT is associated with increased mortality [25]. The poor outcomes in patients with BSI may be multifactorial, including prolonged and profound neutropenia, the disruption of protective barriers such as mucosal surfaces and skin, and more severe immunosuppression [25][26][27]. In the present study the survival outcomes (OS and FFS) of patients with BSI before transplantation were poorer than those of patients without BSI.…”

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

“…Several studies reported risk factors for cephalosporin-resistant, ESBL-pro or MDR bacteria in cancer and HSCT patients [10,12,13,16,22,29,32]. Onl handful describe risk factors for carbapenem-resistant infections in popula involving but not limited to transplant patients, mainly for K. pneumoniae.…”

Clinical Impact of Pretransplant Multidrug-Resistant Gram-Negative Colonization in Autologous and Allogeneic Hematopoietic Stem Cell Transplantation

“…In a recent large prospective Italian multicenter study performed on behalf of Gruppo Italiano Trapianto Midollo Osseo in the HSCT population, the overall survival (OS) at 4 months in patients developing pre-engraftment Pseudomonas aeruginosa and carbapenem-resistant (CR) Klebsiella pneumoniae (CR-Kp) bloodstream infectious (BSI) episodes was 25% and 40%, respectively, with pretransplant carriers having a probability of approximately 30% of development a subsequent colonizing pathogen-related infection [12]. According to some recent studies, patients developing an MDR-GNB infection after allo-HSCT have a poor outcome, so that their eligibility to allogeneic procedure is generally carefully evaluated for the risk-to-benefit ratio [13].…”