G-CSF-primed haplo-identical HSCT with intensive immunosuppressive and myelosuppressive treatments does not increase the risk of pre-engraftment bloodstream infection: a multicenter case–control study

Ren, Jinhua; Lin, Qiaoxian; Chen, Weimin; Lin, Cong-Meng; Zhang, Yuxin; Chen, Cunrong; Chen, Shaozhen; Yuan, Xiaohong; Chen, Ping; Luo, Xiaofeng; Lin, Yun; Shen, Lv-Ying; Guo, Meng-Xian; Chen, Qiuru; Xiao, Min; Chen, Yong Q.; Wu, Xueqiong; Zeng, Yanwei; Chen, Zhizhe; Ma, Xudong; Hu, Jianda; Yang, Ting

doi:10.1007/s10096-019-03482-6

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…The most severe infections in these patients are BSIs, probably because of bone marrow suppression, neutropenia 28 and mucosal injury induced by chemotherapy 29 . The frequency of BSIs was 24.1% in this study, which is much higher than our previously reported for pre-engraftment patients in Ren et al (18.3%) 30 or reported for neutropenic patients in Wisplinghoff et al (14.3%) 7 . The higher rate in our study of HM patients receiving chemotherapy may be explained by the fact that all of the HM patients had long-term central venous catheters (CVC) for delivery of chemotherapy.…”

Section: Discussioncontrasting

confidence: 64%

“…There have been numerous studies about BSI, but relatively few have reported information about the risk factors for developing BSIs in patients with HM receiving chemotherapy. Some reports investigated patients with catheter-related BSI 37 - 38 , while others reported on patients with BSI after hematopoietic stem cell transplantation 2 , 30 . It is known that patients with HM undergoing chemotherapy are at high risk of infection, but the specific risk factors for infection were not well defined.…”

Section: Discussionmentioning

confidence: 99%

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A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Chen¹,

Lin²,

Li³

et al. 2021

J. Cancer

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Background: Bloodstream infection (BSI) is a common and serious complication after patients with hematologic malignancies (HM) receiving chemotherapy. This study examined real-world data seeking to characterize HM BSI and identify risk factors for BSI emergence and mortality. Methods: We retrospectively analyzed the pathogenic epidemiology, antibiotic resistance, and BSI risk factors in a single-center cohort including 3014 consecutive patients with HM receiving chemotherapy between 2013 and 2016. Results of the pathogenic epidemiology were validated via comparison to available reported data. Results: We found that 725 patients (24.1%) had BSIs. Gram-negative (G-) bacteria represented 64.7% of the 744 isolated pathogenic strains, while Gram-positive (G+) bacteria and fungi accounted for 27.7% and 7.7% of the BSIs, respectively. The most common isolates were Klebsiella pneumoniae (19.2%), and 95.1% of the multidrug-resistant strains (MDR) were extended-spectrum beta-lactamase producing strains. G- bacteria were the main microflora responsible for BSI in our cohort of Chinese HM patients compared to studies in developed countries or in neutropenic children with HM or solid tumors. Multivariate analysis revealed that male sex, age ≥ 45 and < 65 yr, hospital length of stay ≥ 9d, neutropenia ≥ 7d before cultures, ≥ 2 antibiotics, and infections (gastrointestinal, perirectal, or urinary tract) independently predicted BSI emergence. Furthermore, age ≥ 65 yr, neutropenia ≥ 7d before blood cultures, no HM remission, lower white blood cell count, ≥ 3 antibiotics, respiratory infections, and Acinetobacter baumannii and Stenotrophomonas maltophilia BSI were independent predictors of 30-day mortality. Conclusions: G- bacteria were the predominant microflora during the study period and antibiotic resistance levels of the pathogens detected were high, especially for MDR strains. The mortality of BSI patients was high in this large cohort. Close attention should be paid to the risk factors identified here to facilitate timely and effective clinical management of such patients.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Chen¹,

Lin²,

Li³

et al. 2021

J. Cancer

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“…Subsequently, we further conducted logistic regression analysis to analyse the risk factors for BSI in patients with CMVr. Variables associated with BSI after HSCT were previously reported to include a diagnosis of acute leukaemia and MDS, transplantation from an HLA-mismatched donor and cord blood, an interval from diagnosis to HSCT of ≥190 days, carbapenem therapy, grade 3–4 intestinal mucositis, older age, and the duration of severe neutropenia ( Girmenia et al, 2017 ; Cho et al, 2019 ; Ren et al, 2019 ). Therefore, we selected age, sex, donor origin, intensive conditioning regimen, total body irradiation, ATG dose, and aGVHD severity for logistic regression analysis.…”

Section: Resultsmentioning

confidence: 99%

Reactivation of cytomegalovirus and bloodstream infection and its impact on early survival after allogeneic haematopoietic stem cell transplantation: a multicentre retrospective study

Ren,

Xu,

Sun

et al. 2024

Front. Microbiol.

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Cytomegalovirus reactivation (CMVr) and bloodstream infections (BSI) are the most common infectious complications in patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Both are associated with great high morbidity whilst the BSI is the leading cause of mortality. This retrospective study evaluated the incidence of CMVr and BSI, identified associated risk factors, assessed their impact on survival in allo-HSCT recipients during the first 100 days after transplantation. The study comprised 500 allo-HSCT recipients who were CMV DNA-negative and CMV IgG-positive before allo-HSCT. Amongst them, 400 developed CMVr and 75 experienced BSI within 100 days after allo-HSCT. Multivariate regression revealed that graft failure and acute graft-versus-host disease were significant risk factors for poor prognosis, whereas CMVr or BSI alone were not. Amongst all 500 patients, 56 (14%) developed both CMVr and BSI in the 100 days after HSCT, showing significantly reduced 6-month overall survival (p = 0.003) and long-term survival (p = 0.002). Specifically, in the initial post-transplant phase (within 60 days), BSI significantly elevate mortality risk, However, patients who survive BSI during this critical period subsequently experience a lower mortality risk. Nevertheless, the presence of CMVr in patients with BSI considerably diminishes their long-term survival prospects. This study provides real-world data on the impact of CMVr and BSI following transplantation on survival, particularly in regions such as China, where the prevalence of CMV IgG-positivity is high. The findings underscore the necessity for devising and executing focused prevention and early management strategies for CMVr and BSI to enhance outcomes for allo-HSCT recipients.

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“…The finding that the presence of a bacterial BSI prior to HSCT contributing to an elevated infectious risk is consistent with reports from other centers. 29 , 30 In addition, some studies have reported that pretransplant infection with resistant GNB was highly predictive of a pre‐engraftment infection by a pathogen with the same susceptibility phenotype. 28 , 31 These reinforcing evidences indicate the difficulty in truly eradicating pathogens and underscore the importance of thorough evaluation of residual infection in patients slated for HSCT.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, Microbiology, and Risk Factors of Bacterial Bloodstream Infections in Patients After Allogeneic Hematopoietic Stem Cell Transplantation

Zhang,

Xiong,

Zhang

et al. 2024

IDR

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Purpose To investigate the clinical characteristics, etiology, and risk factors of bacterial bloodstream infection (BSI) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. This study also aimed to provide a clinical basis for early identification of high-risk patients and optimization of empirical antimicrobial treatment. Patients and Methods This is a retrospective study of clinical data during agranulocytosis from 331 patients with hematological malignancies who underwent allo-HSCT at our institute between January 2016 and December 2022. The incidence, distribution and drug resistance patterns, and the risk factors of BSI were analyzed. Results Among the 331 HSCT patients, 250 had febrile neutropenia and 45 cases were found to have BSI. The incidence of BSI in patients with agranulocytosis fever was 18% (45/250). A total of 48 pathogens were isolated during BSI episodes, gram-negative bacteria (GNB) accounted for 70.8% (34/48), gram-positive bacteria (GPB) for 29.2% (14/48). Multivariate analysis revealed that ≥grade 2 acute graft-versus-host disease (aGVHD) and previous BSI within 6 months before HSCT were independently associated with an increased occurrence of BSI. Coagulase-negative staphylococci (CoNS) and Escherichia coli were the most commonly isolated GPB and GNB, respectively. A total of 32 GNB were tested for drug susceptibility, the detection rate of carbapenem-resistant Enterobacteriaceae (CRE) was 12.5% (4/32), and extended-spectrum β-lactamase (ESBL) accounted for 56.3% (18/32). Conclusion BSIs are still a common and severe complication after allo-HSCT. In our center, BSIs in allo-HSCT patients are dominated by gram-negative bacteria and the resistance rate to carbapenem drugs is high. Risk factors for BSI during agranulocytosis were previous BSI within 6 months before HSCT and ≥grade 2 aGVHD.

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G-CSF-primed haplo-identical HSCT with intensive immunosuppressive and myelosuppressive treatments does not increase the risk of pre-engraftment bloodstream infection: a multicenter case–control study

Cited by 6 publications

References 43 publications

A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Reactivation of cytomegalovirus and bloodstream infection and its impact on early survival after allogeneic haematopoietic stem cell transplantation: a multicentre retrospective study

Epidemiology, Microbiology, and Risk Factors of Bacterial Bloodstream Infections in Patients After Allogeneic Hematopoietic Stem Cell Transplantation

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