Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey.
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Girmenia Corrado, Bertaina Alice, Piciocchi Alfonso, Perruccio Katia, Algarotti Alessandra, Busca Alessandro, Cattaneo Chiara, Raiola Anna Maria, Guidi Stefano, Iori Anna Paola, Candoni Anna, Irrera Giuseppe, Milone Giuseppe, Marcacci Giampaolo, Scimè Rosanna, Musso Maurizio, Cudillo Laura, Sica Simona, Castagna Luca, Corradini Paolo, Marchesi Francesco, Pastore Domenico, Alessandrino Emilio Paolo, Annaloro Claudio, Ciceri Fabio, Santarone Stella, Nassi Luca, Farina Claudio, Viscoli Claudio, Rossolini Gian Maria, Bonifazi Francesca, Rambaldi Alessandro, Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)
Аннотация
METHODS: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) 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.
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 a 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 pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant 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 (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P <.001) and auto-HSCT (2.43; 1.22-4.84; P = .01).
CONCLUSIONS: Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB.
CLINICAL TRIALS REGISTRATION: NCT02088840.