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Incidence, risk factors and outcome of pre engraftment Gram-negative bacteremia after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey
Girmenia, C., Bertaina, A., Piciocchi, A., Carotti, A., Algarotti, A., Busca, A., Cattaneo, C., Raiola, A. M., Guidi, S., Iori, A. P., et al
Clinical Infectious Diseases. 2017
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Abstract
Background: Gram-negative bacteremia (GNB) is a major cause of morbidity and mortality in Hematopoietic Stem Cell Transplant (HSCT) and updated epidemiological investigation is advisable. Methods: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1,118 allogeneic HSCT (allo-HSCT) and 1,625 autologous HSCT (auto-HSCT) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. SIGNB-GITMO-AMCLI is registered with ClinicalTrials.gov, number NCT02088840. Results: The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis variables associated with GNB were a diagnosis of acute leukemia, a transplant from HLA-mismatched donor and from cord-blood, older age and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age and no antibacterial prophylaxis in auto-HSCT. A pre-transplant infection by a resistant pathogen was significantly associated with an increased risk of post-transplant infection by the same microorganism in allo-HSCT. Colonization by resistant Gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4-months both in allo-HSCT (HR 2.13, 95% CI 1.45-3.13;p=.0001) and auto-HSCT (HR 2.43, 95% CI 1.22-4.84;p=.012). Conclusions: Pre-engraftment GNB is an independent factor associated with increased mortality at four months from auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB.