Risk factors for mortality in patients with bloodstream infections during the pre-engraftment period after hematopoietic stem cell transplantation

Abstract

BackgroundBloodstream infections (BSI) remain a frequent complication during the pre-engraftment period after hematopoietic stem cell transplantation (HSCT), resulting in high mortality rates. This study evaluated risk factors for mortality in hematopoietic stem cell transplant recipients with BSI in the pre-engraftment period.MethodsThis prospective case control study was performed at the Center of Hematology and Bone Marrow Transplantation in Minsk, Republic of Belarus. Data relating to patient age and gender, date and type of transplantation, conditioning chemotherapy regimen, microorganisms isolated from blood, and antibacterial therapy were prospectively collected from all hematopoietic stem cell recipients with microbiologically proven cases of BSI in the pre-engraftment period. The primary outcome was all-cause 30-day mortality after onset of febrile neutropenia.ResultsA total of 135 adult patients with microbiologically proven BSI after HSCT were studied, with 65.2% of cases caused by gram-negative microorganisms and 21.5% by non-fermenting bacteria. Inadequate empiric antibacterial therapy and isolation of carbapenem-resistant non-fermenting gram-negative bacteria (Acinetobacter baumannii and Pseudomonas aeruginosa) were independently associated with increased all-cause 30-day mortality in these patients.ConclusionThe risk factors for mortality in adult patients with BSI in the pre-engraftment period after HSCT were inadequacy of empirical antibacterial therapy and isolation of carbapenem-resistant A. baumannii or P. aeruginosa.

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…Specific knowledge of resistance patterns in the HCT population is crucial as HCT patients tend to harbor more resistant bacteria compared with the general hospital population. 84 Stoma et al 83 recently showed an increase in 30 day all-cause mortality in patients who received inadequate empirical antibiotics which were defined by: (a) resistance of the isolated microorganisms to the administered antibiotics; (b) empiric antibacterial therapy that was administered 424 h after collection of blood cultures; or (c) a dosing regimen that conflicted with standard dosing recommendations. This finding underscores the importance of knowledge of the local spectrum of pathogens, which is imperative for selecting the appropriate empiric antibacterial regimen.…”

“…82,83 Choice of empirical antimicrobial therapy incorporates patient's clinical manifestation (severity and type of signs and symptoms associated with fever and clinical risk factors for infectious complications), disease severity, and risk factors. Specific knowledge of resistance patterns in the HCT population is crucial as HCT patients tend to harbor more resistant bacteria compared with the general hospital population.…”

Token economy to improve adherence to activities of daily living

“…However, oncology and HSCT patients are at increased risk of developing treatment‐related toxicities such as infections, oral complications, and deconditioning. Bloodstream Infections (BSI) are the most significant cause of mortality in pediatric oncology/HSCT patients, second only to relapse . Oral complications, such as mucositis, affect up to 80% of oncology patients and have a significant impact on patient's oral function, including the basic need to eat, drink, or speak .…”

“…Recent studies indicate that the risk for BSIs, oral complications, and deconditioning can be reduced by participation in key activities of daily living (ADL), including daily bathing, physical activity, and oral hygiene. Despite this, many patients fail to perform these important ADL during their inpatient stay at a time they are most vulnerable . There is a critical need to develop robust and sustainable mechanisms to improve ADL adherence, which will prevent BSI, oral complications, and challenges related to inactivity in high‐risk immune‐compromised pediatric oncology/HSCT patients.…”

“…Bloodstream Infections (BSI) are the most significant cause of mortality in pediatric oncology/HSCT patients, second only to relapse. [5][6][7][8][9] Oral complications, such as mucositis, affect up to 80% of oncology Abbreviations: ADL, activities of daily living; BMT, bone marrow transplant; BSI, bloodstream infections; CHG, chlorhexidine gluconate; HSCT, hematopoietic stem cell transplant patients [10][11][12] and have a significant impact on patient's oral function, including the basic need to eat, drink, or speak. 13 Additionally, BSI from organisms originating in the oral cavity lead to significant morbidity and mortality in this population.…”