Bacterial Blood Stream Infections Negatively Impact on Outcome of Patients Treated With Allogeneic Stem Cell Transplantation: 6 Years Single-Centre Experience

Abstract

BackgroundBlood stream infections (BSIs) represent a major complication of allo-SCT and are a major cause of morbidity and mortality during and after bone marrow aplasia.ObjectivesThe objective of this study was to describe the incidence and outcome of BSIs in a cohort of patients submitted to allo-SCT, in order to track changes of the epidemiology and bacteria resistance.MethodsWe retrospectively analyzed the microbiological data of 162 patients allotransplanted in Brescia University Hospital, over a period of 6 years.ResultsEighty patients experienced a BSIs for a total of 119 isolates. In 77 cases (65%) a Gram positive bacteria was isolated, being coagulase negative Staphilococci the most frequent species (77% of the cases). In 42 cases (35%) a Gram negative bacteria was isolated (E. coli 57% and P. aeruginosa 24%). Fluoroquinolones resistance was frequent (90% for S. epidermidis, 92% for E. coli, 90% for P. aeruginosa). Methycillin resistance of S. epidermidis was 100%, 76% of E. coli were ESBL positive and among P. aeruginosa resistance to carbapenems was 40%. The 2 years overall survival of patients with BSIs vs patients without BSIs was 46% vs 60% (HR1,48, p=0,07). P. aeruginosa and E. coli were the species with the highest mortality (50% and 33%, respectively).ConclusionsThese data confirm that BSIs, mainly sustained by Gram positive bacteria, are frequent in allotransplanted patients (50% of the cases) and may influence the outcome of allotransplanted patients, being antibiotics resistance highly frequent among these bacteria.

Early Blood Stream Infections after BMT are Associated with Cytokine Dysregulation and Poor Overall Survival

“…Gram-positive bacteremias are predominantly caused by either coagulase-negative staphylococci or Enterococcus spp. [4][5][6]8,9]. Gram-negative organisms are isolated in 21% to 50% of BSIs in the BMT setting [4][5][6]8,9].…”

“…[4][5][6]8,9]. Gram-negative organisms are isolated in 21% to 50% of BSIs in the BMT setting [4][5][6]8,9]. The most common gram-negative organisms are Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa [4,[6][7][8][9][10][11][12].…”

“…Gram-negative organisms are isolated in 21% to 50% of BSIs in the BMT setting [4][5][6]8,9]. The most common gram-negative organisms are Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa [4,[6][7][8][9][10][11][12]. Fluoroquinolone-resistant gram-negative bacteria are of highest prevalence in centers with high rates of antibacterial prophylaxis with these agents (50% to 74%) [9,12].…”

Clinical Care of Hematological Patients in a Bone Marrow Transplant Unit: Do Human Resources Influence Infection Incidence?

“…7 Briefly, 60% of the patients were transplanted for acute leukemias and 49% experienced a BSI, for a total of 119 isolates. The median time of blood culture positivity was 19 days from transplant (range day −4 to day +921).…”

High Levels of Hand-Hygiene Compliance Are a Worthwhile Pursuit

“…Trials in the adult population have included patients with long-term central venous catheters, such as dialysis, oncology, and PN patients, and have shown variable results. [5][6][7][8] The goal of this study was to further evaluate benefits of adding prophylactic ELT to all patients with silicone-based tunneled catheters in adult patients on home PN for an advanced form of intestinal failure (type 2 or type 3) as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN). 9 The primary outcomes evaluated were the rates of CLABSI and resulting hospitalizations in patients before and after the initiation of the ELT protocol.…”