Risk factors for pre‐ and post‐engraftment bloodstream infections after allogeneic hematopoietic stem cell transplantation

Kikuchi, Misato; Akahoshi, Yu; Nakano, Hirofumi; Ugai, Tomotaka; Wada, Hiroo; Yamasaki, Ryo; Sakamoto, Kana; Kawamura, Koji; Ishihara, Yuko; Sato, Miki; Ashizawa, Masahiro; Terasako‐Saito, Kiriko; Kimura, Shun‐ichi; Yamazaki, Rie; Kanda, Junya; Kako, Shinichi; Nishida, Junji

doi:10.1111/tid.12345

Cited by 61 publications

(71 citation statements)

References 18 publications

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“…Kikuchi et al 20 showed similar results in their retrospective review, noting that BSIs were more common in the pre-(39% of patients) vs post-engraftment (17% of patients) periods. During the pre-engraftment period, important risk factors for BSI are neutropenia, presence of a CVC and severe mucositis.…”

Section: Epidemiologysupporting

confidence: 59%

“…21 In multivariate analysis, pre-engraftment BSI has been associated with engraftment failure and high-risk disease status at the time of HCT. 20 Post-engraftment BSIs are more commonly found in patients who undergo allo-HCT and have a history of acute (aGvHD) or chronic GvHD (cGvHD). Patients with post-engraftment BSI received more antibacterial prophylaxis, previous antibiotic therapy and immunosuppression (corticosteroids and cyclosporine) than patients without BSI.…”

Section: Epidemiologymentioning

confidence: 99%

“…20 In pediatric populations, non-malignant diseases are associated with higher BSI risk than malignant diseases. 5,35 …”

Section: Conditioning Regimenmentioning

confidence: 99%

“…Patients with post-engraftment BSI received more antibacterial prophylaxis, previous antibiotic therapy and immunosuppression (corticosteroids and cyclosporine) than patients without BSI. 20,21 In addition, patients with postengraftment BSIs traditionally have poorer outcomes, with higher early and all-cause fatality rates. 21 …”

Section: Epidemiologymentioning

confidence: 99%

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

Dandoy

Ardura

Papanicolaou

et al. 2017

Bone Marrow Transplant

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Bacterial bloodstream infections (BSI) cause significant transplant-related morbidity and mortality following allogeneic hematopoietic cell transplantation (allo-HCT). This manuscript reviews the risk factors for and the bacterial pathogens causing BSIs in allo-HCT recipients in the contemporary transplant period. In addition, it offers insight into emerging resistant pathogens and reviews clinical management considerations to treat and strategies to prevent BSIs in allo-HCT patients.

show abstract

Section: Epidemiologysupporting

confidence: 59%

Section: Epidemiologymentioning

confidence: 99%

“…20 In pediatric populations, non-malignant diseases are associated with higher BSI risk than malignant diseases. 5,35 …”

Section: Conditioning Regimenmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

See 2 more Smart Citations

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

Dandoy

Ardura

Papanicolaou

et al. 2017

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…11,14,16,19,27,29,35,36,39 Haematological malignancies represented the main cause of neutropenia; seven studies included also patients with solid cancer (ranging from 5% to 44% of the patient population). Acute leukaemia was the most common haematological disease in 17 (57%) studies.…”

Section: 39mentioning

confidence: 99%

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

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Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

et al. 2019

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Severe infections (SI) significantly impact on non‐relapse mortality after hematopoietic stem cell transplantation (HSCT). We assessed 432 children and adolescents with acute lymphoblastic leukemia (ALL) after total body irradiation based myeloablative HSCT within the multicenter ALL‐BFM‐SCT 2003 trial for SI grade 3 or higher according to common terminology criteria for adverse events. A total 172 patients experienced at least one SI. Transplantation from matched unrelated donors (MUD) was associated with any type of SI in the pre‐engraftment period (hazard ratio [HR]: 2.57; P < .001), and with any SI between day +30 and + 100 (HR: 2.91; P = .011). Bacterial (HR: 2.24; P = .041) and fungal infections (HR: 4.06; P = .057) occurred more often in the pre‐engraftment phase and viral infections more often before day +30 (HR: 2.66; P = .007) or between day +30 and + 100 (HR: 3.89; P = .002) after HSCT from MUD as compared to matched sibling donors. Chronic GvHD was an independent risk factor for any type of SI after day +100 (HR: 2.57; P < .002). We conclude that allogeneic HSCT from MUD in children and adolescents with pediatric ALL is associated with higher infection rates, which seems attributable to an intensified GvHD prophylaxis including serotherapy and methotrexate.

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Risk factors for pre‐ and post‐engraftment bloodstream infections after allogeneic hematopoietic stem cell transplantation

Cited by 61 publications

References 18 publications

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

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

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

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