A M Ferreira1, F Moreira2, T Guimaraes3, F Spadão3, J F Ramos4, M V Batista4, J S Filho2, S F Costa5, V Rocha6. 1. Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: ali_ferreira@hotmail.com. 2. Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil. 3. Infection Control Committee of Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil. 4. Department of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil. 5. Laboratory of Bacteriology, Tropical Medicine Institute, University of Sao Paulo, Sao Paulo, Brazil; Department of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil. 6. Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil; Haematology Department, NHS BT, Oxford University, Oxford, UK.
Abstract
BACKGROUND: Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT). AIM: To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality. METHODS: Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome. Covariates with P < 0.10 on univariate analysis were included in a multiple Cox regression analysis using a backward elimination method. FINDINGS: The cumulative incidence of BSI was 25.4%, mainly caused by Gram-negative bacteria (GNB) (55.2%). Approximately 40.5% of the patients had gut colonization by multi-drug-resistant (MDR) bacteria (vancomycin-resistant enterococcus and carbapenem-resistant GNB). Among patients colonized by MDR GNB, 20% developed an overt BSI due to MDR bacteria with the same pattern of sensitivity. Of the 13 deaths related to infection, 10 were patients with BSI caused by MDR GNB. The independent risk factors for BSI were gut colonization by MDR bacteria including GNB (P < 0.001) and duration of neutropenia >10 days (P = 0.005), and those associated with BSI caused by MDR bacteria were age >62 years (P = 0.03), use of total parenteral nutrition (TPN) (P < 0.001) and previous gut colonization by MDR GNB (P = 0.002). CONCLUSIONS: Previous gut colonization by MDR was an independent risk factor for BSI, together with TPN and age, and had an impact on outcome. These findings suggest that gut decolonization may be a potential strategy to prevent BSI.
BACKGROUND: Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT). AIM: To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality. METHODS: Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome. Covariates with P < 0.10 on univariate analysis were included in a multiple Cox regression analysis using a backward elimination method. FINDINGS: The cumulative incidence of BSI was 25.4%, mainly caused by Gram-negative bacteria (GNB) (55.2%). Approximately 40.5% of the patients had gut colonization by multi-drug-resistant (MDR) bacteria (vancomycin-resistant enterococcus and carbapenem-resistant GNB). Among patients colonized by MDR GNB, 20% developed an overt BSI due to MDR bacteria with the same pattern of sensitivity. Of the 13 deaths related to infection, 10 were patients with BSI caused by MDR GNB. The independent risk factors for BSI were gut colonization by MDR bacteria including GNB (P < 0.001) and duration of neutropenia >10 days (P = 0.005), and those associated with BSI caused by MDR bacteria were age >62 years (P = 0.03), use of total parenteral nutrition (TPN) (P < 0.001) and previous gut colonization by MDR GNB (P = 0.002). CONCLUSIONS: Previous gut colonization by MDR was an independent risk factor for BSI, together with TPN and age, and had an impact on outcome. These findings suggest that gut decolonization may be a potential strategy to prevent BSI.
Authors: Joyce Ji; Jeff Klaus; Jason P Burnham; Andrew Michelson; Colleen A McEvoy; Marin H Kollef; Patrick G Lyons Journal: Chest Date: 2020-06-17 Impact factor: 9.410