Corrado Girmenia1, Alice Bertaina2, Alfonso Piciocchi3, Katia Perruccio4, Alessandra Algarotti5, Alessandro Busca6, Chiara Cattaneo7, Anna Maria Raiola8, Stefano Guidi9, Anna Paola Iori1, Anna Candoni10, Giuseppe Irrera11, Giuseppe Milone12, Giampaolo Marcacci13, Rosanna Scimè14, Maurizio Musso15, Laura Cudillo16, Simona Sica17, Luca Castagna18, Paolo Corradini19, Francesco Marchesi20, Domenico Pastore21, Emilio Paolo Alessandrino22, Claudio Annaloro23, Fabio Ciceri24, Stella Santarone25, Luca Nassi26, Claudio Farina27, Claudio Viscoli28, Gian Maria Rossolini29,30, Francesca Bonifazi31, Alessandro Rambaldi5,32. 1. Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome. 2. Unità Operativa di Oncoematologia, Ospedale pediatrico Bambino Gesù. 3. Fondazione GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto), Rome. 4. Struttura Complessa di Ematologia con Trapianto, Ospedale Santa Maria della Misericordia; Perugia. 5. Divisione di Ematologia, ASST Papa Giovanni XXIII, Bergamo. 6. Dipartimento di Oncologia ed Ematologia A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, Turin. 7. Unità Operativa di Ematologia, Azienda Spedali Civili, Brescia. 8. Ematologia e Trapianto di Midollo, Ospedale Policlinico San Martino, Genoa. 9. Cattedra di Ematologia, Azienda Ospedaliera Universitaria Careggi, Florence. 10. Clinica Ematologica e Unità di Terapie Cellulari 'Carlo Melzi'- Azienda Ospedaliera-Universitaria, Udine. 11. Divisione di Ematologia Centro Unico Regionale TMO e Terapie Emato-Oncologiche Sovramassimali "A. Neri" Ospedale Bianchi-Melacrino-Morelli, Reggio Calabria. 12. Divisione di Ematologia e Programma di Trapianto Emopoietico Azienda Policlinico Vittorio Emanuele-Catania. 13. Dipartimento di Ematologia, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, UOC di Ematologia Oncologica e Trapianto di Cellule Staminali, Napoli. 14. UOC di Ematologia, A.O. Ospedali Riuniti Villa Sofia-Cervello. 15. U.O. Oncoematologia e TMO, Casa di Cura "La Maddalena", Palermo. 16. Fondazione Policlinico Tor Vergata, Unità di Trapianto Cellule Staminali, University Tor Vergata. 17. Divisione di Ematologia-Istituto di Ematologia, Policlinico A. Gemelli, Università Cattolica S. Cuore, Rome. 18. Humanitas Cancer Center, Humanitas Research, Rozzano. 19. Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan. 20. UOSD di Ematologia e Trapianti, Istituto Nazionale Tumori Regina Elena, IFO, Rome. 21. Ematologia con Trapianto, Dipartimento di Emergenza e Trapianto d'Organo, University of Bari. 22. UOC ematologia, Dipartimento Oncoematologico, Fondazione IRCCS Policlinico San Matteo, Pavia. 23. Centro Trapianti di Midollo, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico. 24. Unità operative di Ematologia e Trapianto Midollo Osseo, Ospedale San Raffaele, Milan. 25. UOC di Trapianto Emopoietico, Ospedale Spirito Santo, Pescara. 26. SCDU Ematologia, AOU Maggiore della Carità, Novara. 27. UOC Microbiologia e Virologia, Azienda Ospedaliera ASST Papa Giovanni XXIII, Bergamo. 28. Infectious Diseases Unit, IRCCS AOU San Martino-IST,University of Genoa. 29. Dipartimento di Medicina Sperimentale e Clinica, University of Florence. 30. SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi, Florence. 31. Istituto di Ematologia e Oncologia Medica, L. e A Seragnoli, Policlinico S.Orsola Malpigli, Bologna. 32. Dipartimento di Oncologia, University of Milan.
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.
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.
Authors: Michael J Satlin; Liang Chen; Claire Douglass; Michael Hovan; Emily Davidson; Rosemary Soave; Marisa La Spina; Alexandra Gomez-Arteaga; Koen van Besien; Sebastian Mayer; Adrienne Phillips; Jing-Mei Hsu; Rianna Malherbe; Catherine B Small; Stephen G Jenkins; Lars F Westblade; Barry N Kreiswirth; Thomas J Walsh Journal: Clin Infect Dis Date: 2021-10-05 Impact factor: 20.999