Secular trends of bloodstream infections during neutropenia in 15 181 haematopoietic stem cell transplants: 13-year results from a European multicentre surveillance study (ONKO-KISS)

Abstract

The incidence of Gram-negative BSI significantly increased over time in this vulnerable patient population, providing evidence for reevaluating empiric therapy for neutropenic fever in HSCT patients.

Impact of choice, timing, sequence and combination of broad-spectrum antibiotics on the outcome of allogeneic haematopoietic stem cell transplantation

“…From a clinical point of view, this information is of high relevance. As bloodstream infections remain a major cause of non-relapse mortality in patients undergoing aSCT, 16 empirical use of broad-spectrum antimicrobials continues as a cornerstone of supportive care in haematology. Common empirical strategies in the aSCT unit often include (i) continuation of antibiotic treatment until engraftment, even after defervescence and clinical improvement 17 and (ii) switch to a different class of broadspectrum antibiotics with the aim of a so-called escalation of antibiotic coverage in case of persistent febrile neutropenia.…”

Contribution of specific pathogens to bloodstream infection mortality in neutropenic patients with hematologic malignancies: Results from a multicentric surveillance cohort study

“…With a mortality of 6% and the need for intensive care treatment for 15% of patients within 7 days after BSI due to KES, this group of gram‐negative enteric rods was also associated with poor outcomes in our study. We have previously reported a low prevalence of cephalosporin resistance (presumably most often ESBL‐related) and carbapenemase‐producing Enterobacteriales in ONKO‐KISS centers during our observation period . For the study period, for which information on cephalosporin resistance was available, only resistant KES but not susceptible KES were associated with early BSI mortality.…”

“…This study analyzed data collected in a prospective, multicenter, multinational (Germany, Austria, Switzerland) surveillance program of patients with BSI during neutropenia subsequent to high‐dose chemotherapy for acute leukemia (HDC) or autologous or allogeneic hematopoietic stem cell transplantation (auto‐HSCT or allo‐HSCT) from the beginning of 2002 through April 2015. The study cohort and methods have been described previously …”

“…Bloodstream infection was defined according to CDC criteria, either as growth of pathogenic bacteria from a single blood culture or as cultivation of skin commensals from a single blood culture (study period 2002 ‐ 2010) or two independent blood culture sets (from 2011 onwards) in combination with patient symptoms of pyrexia ≥ 38.0°C, shivering or, hypotension . Early‐onset BSI was defined as occurring in the first 7 days of neutropenia.…”

“…ONKO‐KISS is an ongoing, prospective surveillance system for selected infections in neutropenic patients treated with induction or consolidation chemotherapy for hematologic malignancies including centers in Germany, Austria, and Switzerland. Previous reports from the ONKO‐KISS surveillance cohort have described the overall cohort and methods of surveillance, the changes in BSI microbiology over a 12‐year period, and the impact of fluoroquinolone prophylaxis on BSI …”