Background Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. 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.
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.; Perruccio, K.; Algarotti, A.; Busca, A.; Cattaneo, C.; Raiola, A. M.; Guidi, S.; Iori, A. P.; Candoni, A.; Irrera, G.; Milone, G.; Marcacci, G.; Scime, R.; Musso, M.; Cudillo, L.; Sica, S.; Castagna, L.; Corradini, P.; Marchesi, F.; Pastore, D.; Alessandrino, E. P.; Annaloro, C.; Ciceri, F.; Santarone, S.; Nassi, L.; Farina, C.; Viscoli, C.; Rossolini, G. M.; Bonifazi, F.; Rambaldi, A.; Capria, S.; Bertaina, A.; Mastronuzzi, A.; Pagliara, D.; Bernaschi, P.; Amico, L.; Carotti, A.; Mencacci, A.; Busca, A.; Bruno, B.; Costa, C.; Passi, A.; Ravizzola, G.; Angelucci, E.; Marchese, A.; Pecile, P.; Candoni, A.; Ventura, G.; Fanin, R.; Scarparo, C.; Barbaro, A.; Leotta, S.; Marchese, A. E.; Marcacci, G.; Becchimanzi, C.; Donnarumma, D.; Tringali, S.; Baldi, M. T.; Scalone, R.; Cudillo, L.; Picardi, A.; Arcese, W.; Fontana, C.; Sica, S.; Giammarco, S.; Spanu, T.; Crocchiolo, R.; Casari, E.; Mussetti, A.; Conte, E.; Ensoli, F.; Miragliotta, G.; Marone, P.; Arghittu, M.; Greco, R.; Forcina, A.; Chichero, P.; Santarone, S.; Di Bartolomeo, P.; Fazii, P.; Kroumova, V.; Decembrino, N.; Zecca, M.; Pisapia, G.; Palazzo, G.; Lanino, E.; Faraci, M.; Castagnola, E.; Bandettini, R.; Pastano, R.; Sammassimo, S.; Passerini, R.; Stefani, P. M.; Gherlinzoni, F.; Rigoli, R.; Prezioso, L.; Cambo, B.; Calderaro, A.; Carella, A. M.; Cascavilla, N.; Labonia, M. T.; Celeghini, I.; Mordini, N.; Piana, F.; Vacca, A.; Sanna, M.; Podda, G.; Corsetti, M. T.; Rocchetti, A.; Cilloni, D.; De Gobbi, M.; Bianco, O.; Fagioli, F.; Carraro, F.; De Intinis, G.; Severino, A.; Proia, A.; Parisi, G.; Vallisa, D.; Confalonieri, M.; Russo, D.; Malagola, M.; Galieni, P.; Falcioni, S.; Travaglini, V.; Raimondi, R.; Borghero, C.; Pavan, G.; Prete, A.; Belotti, T.; Ambretti, S.; Imola, M.; Mianulli, A. M.; Pedna, M. F.; Cesaro, S.; Lo Cascio, G.; Ferrari, A.; Piedimonte, M.; Santino, I.; Calandrelli, M.; Olivieri, A.; Orecchioni, F.; Mirabile, M.; Centurioni, R.; Gironacci, L.; Caravelli, D.; Gallo, S.; De Filippi, M.; Cupelli, L.; Dentamaro, T.; Falco, S.; Eugenio, O. S.; Marotta, S.; Risitano, A.; Lula, D.; Musto, P.; Pietrantuono, G.; Traficante, A.; Cerchiara, E.; Tirindelli, M. C.; Dicuonzo, G.; Chierichini, A.; Anaclerico, B.; Placanica, P.. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 65:11(2017), pp. 1884-1896. [10.1093/cid/cix690]
Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey
Calderaro A.;Russo D.;Ambretti S.;
2017-01-01
Abstract
Background Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
