Bacterial blood stream infections (BSIs), particularly post-engraftment BSIs, are associated with increased mortality after allogeneic hematopoietic cell transplantation

Abstract

We analyzed CIBMTR data to evaluate the incidence of non-relapse mortality (NRM) and association with overall survival (OS) for Bacterial blood stream infections (BSIs) occurring within 100 days of alloHCT in 2 different phases: pre/peri engraftment (BSI very early phase, BSI-VEP) and BSI post engraftment (BSI occurring between 2 weeks after engraftment and Day100, late early phase, BSI-LEP). Of 7,128 alloHCT patients, 2,656 (37%) had ≥1 BSI by day100. BSI-VEP, BSI-LEP, BSI-Both constituted 56% (n=1492), 31% (n=824), and 13% (n=340) of total BSI, respectively. Starting in 2009 we observed a gradual decline in BSI incidence through 2012 (61% to 48%). Patients with BSI-VEP were more likely to receive a myeloablative conditioning (MAC) regimen with total body irradiation (TBI). NRM was significantly higher in patients with any BSI (RR 1.82 95CI 1.63–2.04 for BSI-VEP, RR 2.46, 95%CI 2.05–2.96 for BSI-LEP, and RR 2.29, 95%CI 1.87–2.81 for BSI-Both) compared with those without BSI. OS was significantly lower in patients with any BSI compared with patients without BSI (RR 1.36, 95%CI 1.26–1.47 for BSI-VEP; RR 1.83, 95%CI 1.58–2.12 for BSI-LEP: RR 1.66, 95%CI 1.43–1.94 for BSI-Both). BSIs within day100 after alloHCT are common and remain a risk factor for mortality.

Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem cell transplant patients

“…To account for disease progression as the cause of death, we determined which patients had advanced directives in place at the time of infection ( n = 14). It is difficult, however, to measure the impact of BSI on survival; in HSCT patients, BSI are an independent risk factor for mortality, independent of death directly related to infection; and in PHO patients, BSI are associated with increased mortality . It is possible patients who develop BSI develop perturbations in gut microbiome secondary to antibiotic use, along with intestinal inflammation .…”

Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury–Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant

“…Transplant strategies and supportive care have evolved, resulting in improved overall survival (OS) 6 ; however, patients who have undergone HSCT remain at high risk for bloodstream infections (BSIs) and associated morbidity and mortality. 5,7,8 Studies have identified immunocompromised patients, including those who have undergone HSCT, who are at risk of developing BSIs once classified as central line-associated BSIs (CLABSIs) that do not result from contamination of the central venous catheter but instead from other mechanisms such as translocation of bacteria through nonintact mucosa. 9,10 The Centers for Disease Control and Prevention developed a modification of the CLABSI definition, termed mucosal barrier injurylaboratory confirmed bloodstream infection (MBI-LCBI) through literature review and expert opinion.…”

Epidemiology, utilisation of healthcare resources and outcome of invasive fungal diseases following paediatric allogeneic haematopoietic stem cell transplantation

“…Bacterial, viral and fungal infections are frequently observed in children and adolescents post‐transplant . Invasive fungal disease (IFD) is a life‐threatening condition.…”

“…[3][4][5] Bacterial, viral and fungal infections are frequently observed in children and adolescents post-transplant. [6][7][8] Invasive fungal disease (IFD) is a life-threatening condition. Early detection is crucial, but still difficult despite recent progress in the diagnosis of IFDs in immunocompromised hosts.…”