Incidence, Risk Factors, Microbiology and Outcomes of Pre-engraftment Bloodstream Infection After Haploidentical Hematopoietic Stem Cell Transplantation and Comparison With HLA-identical Sibling Transplantation

Yan, Chen‐Hua; Wang, Yu; Mo, Xiao‐Dong; Sun, Yu‐Qian; Wang, Feng-Rong; Fu, Hai-Xia; Yao, Chen; Han, Tingting; Kong, Jun; Cheng, Yifei; Zhang, Xiao-Hui; Xu, Lei; Liu, Kai-Yan; Huang, Xiao‐Jun

doi:10.1093/cid/ciy658

Cited by 39 publications

(37 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…Treatments for hematological malignancies (HM) mainly include radiotherapy, chemo-and targeted-therapy, and hematopoietic stem cell transplantation (HSCT). It is known that chemotherapies and intensive conditioning regimens prior to HSCT can cause mucosal damage, depressed immunity, and neutropenia, all of which can contribute to Bloodstream infection (BSI) development [1][2][3]. Although there have been many great progresses made in recent decades for the treatment of HM, especially the exciting advances in HSCT [4][5], BSIs remain a serious threat to HM patients [3,6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

show abstract

“…All other patients were classified into the high-risk group. Antecedent infection was defined as any infection occurred before the onset of AP in the case group or before the end of follow-up in the control group [26][27][28]. The diagnoses of acute GVHD (aGVHD) and chronic GVHD (cGVHD) were assigned to patients and graded afterward based on consensus conference on aGVHD and cGVHD grading [29,30].…”

Section: Definitions and Evaluationsmentioning

confidence: 99%

Incidence, Risk Factors, Outcomes, and Risk Score Model of Acute Pancreatitis after Allogeneic Hematopoietic Stem Cell Transplantation

Wang

Han

Zhao

et al. 2020

Biology of Blood and Marrow Transplantation

Self Cite

View full text Add to dashboard Cite

Acute pancreatitis (AP) has been recognized as an uncommon yet potentially lethal complication after hematopoietic stem cell transplant (HSCT). This retrospective, nested, case-control study reviewed data from 5284 consecutive patients who underwent allogeneic (allo)-HSCT between 2009 and 2018 at a single center, identifying 40 patients (0.76%) with AP after allo-HSCT. The diagnosis and severity of AP were established and classified according to existing criteria. Younger age (P = .008), grades II to IV acute graft-versus-host disease (P = .010), a history of donor lymphocyte infusion (P = .033), and pre-existing gallstones (P = .003) were independent risk factors of AP after allo-HSCT. Post-transplant AP had a trend to negatively influence overall survival (OS) and nonrelapse mortality (NRM) (P = .063) for allo-HSCT recipients, but no significant difference was found. Patients with moderately severe and severe AP had significantly lower OS (P = .002) and higher NRM (P = .000) than other patients. Based on these findings, a risk score model was also established to predict the occurrence of AP. Our risk score model performed well in terms of discrimination when applied to derivation samples. Patients were classified into a low-risk group (0 to 1 point), a medium-risk group (2 to 3 points), and a high-risk group (4 points or more). Significant difference was observed in AP incidence among the 3 groups. The predictive tool explored by our study might contribute to target high-risk patients and guide personalized AP prevention in allo-HSCT recipients.

show abstract

“…Bloodstream infections (BSI) are the most common severe infections and are a major cause of mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (alloSCT) [ 12 ], with an incidence ranging from 13 to 46% [ 13 ]. Many risk factors for BSI and severe infectious complications exist, such as prolonged severe neutropenia, myeloablative conditioning regimens, severe mucosal damage, use of broad-spectrum antibiotics; acute graft versus host disease, prolonged corticosteroids, and previous infectious history [ 13 – 16 ]. Moreover, delayed immune recovery, as seen with ex-vivo T cell-depleted alloSCT leads to high incidence of late infections in the haploSCT setting, as reported with the Perugia platforms [ 1 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide

Esquirol

Pascual

Kwon

et al. 2021

Bone Marrow Transplant

View full text Add to dashboard Cite

Severe infections and their attributable mortality are major complications in recipients of allogeneic hematopoietic stem cell transplantation (alloSCT). We herein report 236 adult patients who received haploSCT with PTCy. The median follow-up for survivors was 37 months. The overall incidence of bloodstream infections by gram-positive and gram-negative bacteria at 37 months was 51% and 46%, respectively. The incidence of cytomegalovirus infection was 69%, while Epstein Barr virus infections occurred in 10% of patients and hemorrhagic cystitis in 35% of cases. Invasive fungal infections occurred in 11% at 17 months. The 3-year incidence of infection-related mortality was 19%. The median interval from transplant to IRM was 3 months (range 1–30), 53% of IRM occurred >100 days post-haploSCT. Risk factors for IRM included age >50 years, lymphoid malignancy, and developing grade III-IV acute GvHD. Bacterial infections were the most common causes of IRM (51%), mainly due to gram-negative bacilli BSI. In conclusion, severe infections are the most common causes of NRM after haploSCT with PTCy, with a reemergence of gram-negative bacilli as the most lethal pathogens. More studies focusing on the severe infections after haploSCT with PTCy and differences with other types of alloSCT in adults are clearly warranted.

show abstract

Incidence, Risk Factors, Microbiology and Outcomes of Pre-engraftment Bloodstream Infection After Haploidentical Hematopoietic Stem Cell Transplantation and Comparison With HLA-identical Sibling Transplantation

Cited by 39 publications

References 28 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

Incidence, Risk Factors, Outcomes, and Risk Score Model of Acute Pancreatitis after Allogeneic Hematopoietic Stem Cell Transplantation

Severe infections and infection-related mortality in a large series of haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide

Contact Info

Product

Resources

About