Diana Averbuch1, Gloria Tridello2, Jennifer Hoek3, Malgorzata Mikulska4, Thomas Pabst5, Lucrecia Yaňez San Segundo6, Hamdi Akan7, Tülay Özçelik8, Irene Donnini9, Galina Klyasova10, Aida Botelho de Sousa11, Tsila Zuckerman12, Cristina Tecchio13, Rafael de la Camara14, Sahika Zeynep Aki15, Per Ljungman16, Zafer Gülbas17, Emmanuelle Nicolas-Virelizier18, Elisabetta Calore19, Katia Perruccio20, Ron Ram21, Claudio Annaloro22, Rodrigo Martino23, Batia Avni24, Peter J Shaw25, Alexandra Jungova26, Katia Codeluppi27, Tracey O'Brien28, Anna Waszczuk-Gajda29, Montserrat Batlle30, Anastasia Pouli31, Catherina Lueck32, Lidia Gil33, Simona Iacobelli34, Jan Styczynski35, Dan Engelhard36, Simone Cesaro37. 1. Hadassah University Hospital, Jerusalem, Israel. Electronic address: dina8282@walla.co.il. 2. Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy. Electronic address: gloria.tridello@aovr.veneto.it. 3. EBMT Data Office, Leiden, the Netherlands. Electronic address: idwp.ebmt@lumc.nl. 4. Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy. Electronic address: m.mikulska@unige.it. 5. Department of Medical Oncology, University Hospital Bern, Bern, Switzerland. Electronic address: thomas.pabst@insel.ch. 6. Hospital U. Marqués de Valdecilla, Santander, Spain. Electronic address: lucrecia@humv.es. 7. Ankara University Faculty of Medicine, Ankara, Turkey. Electronic address: hamdiakan@gmail.com. 8. Bilim University, Florence Nightingale Hospital, Istanbul, Turkey. Electronic address: tulay.ozcelik@hotmail.com. 9. Azienda Ospedaliera Universitaria Careggi, Firenze, Italy. Electronic address: irdonni@tin.it. 10. National Research Center for Hematology, Moscow, Russian Federation. Electronic address: klyasova.g@blood.ru. 11. Hospital dos Capuchos, Lisboa, Portugal. Electronic address: aida.botelho@chlc.min-saude.pt. 12. Rambam Medical Center, Haifa, Israel. Electronic address: t_zuckerman@rambam.health.gov.il. 13. Department of Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy. Electronic address: cristina.tecchio@univr.it. 14. Hospital de la Princesa, Madrid, Spain. Electronic address: jrcamara@telefonica.net. 15. Gazi University Faculty of Medicine, Ankara, Turkey. Electronic address: sahikazeynep@gmail.com. 16. Karolinska University Hospital, Stockholm, Sweden. Electronic address: per.ljungman@ki.se. 17. Anadolu Medical Center Hospital, Kocaeli, Turkey. Electronic address: zafer.gulbas@anadolusaglik.org. 18. Centre Leon Berard, Lyon, France. Electronic address: emmanuelle.nicolas@lyon.unicancer.fr. 19. Clinica di Oncoematologia Pediatrica, Padova, Italy. Electronic address: elisabetta.calore@unipd.it. 20. Ospedale Santa Maria della Misericordia, Università di Perugia, Perugia, Italy. Electronic address: katia.perruccio@ospedale.perugia.it. 21. Tel Aviv Sourasky Medical Center, Sourasky Medical School, Tel Aviv University, Tel Aviv, Israel. Electronic address: ronr@tlvmc.gov.il. 22. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. Electronic address: cannaloro@gmail.com. 23. Hospital Santa Creu I Sant Pau, Barcelona, Spain. Electronic address: rmartino@santpau.cat. 24. Hadassah University Hospital, Jerusalem, Israel. Electronic address: batiaa@hadassah.org.il. 25. The Children's Hospital at Westmead, Sydney, Australia. Electronic address: peter.shaw@health.nsw.gov.au. 26. Charles University Hospital, Pilsen, Czech Republic. Electronic address: jungovaa@fnplzen.cz. 27. Hematology, Azienda Unità Sanitaria Locale -IRCCS di Reggio Emilia, Italy. Electronic address: codeluppi.katia@asmn.re.it. 28. Sydney Children's Hospital, Randwick Sydney, Australia. Electronic address: t.obrien@unsw.edu.au. 29. The Medical University of Warsaw, Warsaw, Poland. Electronic address: annawaszczukgajda@gmail.com. 30. ICO-Hospital Universitari Germans Trias I Pujol, Badalona, Spain. Electronic address: mbatlle@iconcologia.net. 31. St. Savvas Oncology Hospital, Athens, Greece. Electronic address: a.pouli@hotmail.gr. 32. Hannover Medical School, Hannover, Germany. Electronic address: Lueck.Catherina@mh-hannover.de. 33. University of Medical Sciences, Poznan, Poland. Electronic address: lidia.gil@skpp.edu.pl. 34. Tor Vergata University, Rome, Italy. Electronic address: simona.iacobelli@ebmt.org. 35. Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland. Electronic address: jstyczynski@cm.umk.pl. 36. Hadassah University Hospital, Jerusalem, Israel. Electronic address: engelhard@hadassah.org.il. 37. Pediatric Hematology Oncology, Mother and Child Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy. Electronic address: simone.cesaro@aovr.veneto.it.
Abstract
OBJECTIVES: We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. METHODS: Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). RESULTS: The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7-9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5-7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6-7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4-1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. CONCLUSIONS: Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.
OBJECTIVES: We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. METHODS: Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). RESULTS: The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7-9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5-7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6-7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4-1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. CONCLUSIONS: Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.
Authors: Anne-Marie Chaftari; Ray Hachem; Alexandre E Malek; Victor E Mulanovich; Ariel D Szvalb; Ying Jiang; Ying Yuan; Shahnoor Ali; Rita Deeba; Patrick Chaftari; Issam Raad Journal: Open Forum Infect Dis Date: 2022-02-14 Impact factor: 4.423