Botond Lakatos1, Helga Szabó2, Katalin Csordás3, Gábor Tatai4, Radka Nikolova5, Judit Csomor6, Péter Reményi7, Tamás Masszi8, István Vályi-Nagy7, János Sinkó7. 1. Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály, Dél-pesti Centrumkórház Budapest. 2. Radiológiai és Onkoterápiás Klinika, Semmelweis Egyetem Budapest. 3. Országos Hematológiai és Infektológiai Intézet, Gyermekhematológiai és Őssejt-transzplantációs Osztály, Dél-pesti Centrumkórház Budapest. 4. Általános Orvostudományi Kar, Semmelweis Egyetem Budapest. 5. Országos Hematológiai és Infektológiai Intézet, Mikrobiológiai Laboratórium, Dél-pesti Centrumkórház Budapest. 6. Általános Orvostudományi Kar, I. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem Budapest. 7. Országos Hematológiai és Infektológiai Intézet, Hematológiai Osztály, Dél-pesti Centrumkórház Budapest, Albert Flórián út 5-7., 1097. 8. Általános Orvostudományi Kar, III. Belgyógyászati Klinika, Semmelweis Egyetem Budapest.
Abstract
Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.
Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphomapatients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.
Authors: Roaa S Gassas; Ahmed N Absi; Abdulrahman A Alghamdi; Ahmed S Alsaeed; Sameer M Alamoudi; Ihab Y Hemaidi; Majed D Alahmadi; Walaa A Rajkhan; Mannar M Khalil; Saleem K Dadah; Ahmed S Higazi; Amani S Ahmed Journal: Saudi Med J Date: 2021-08 Impact factor: 1.422