Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

被引：115

作者：

Girmenia, Corrado ^{[1
]}

Bertaina, Alice ^{[2
]}

Piciocchi, Alfonso ^{[3
]}

Perruccio, Katia ^{[4
]}

Algarotti, Alessandra ^{[5
]}

Busca, Alessandro ^{[6
]}

Cattaneo, Chiara ^{[7
]}

Raiola, Anna Maria ^{[8
]}

Guidi, Stefano ^{[9
]}

Iori, Anna Paola ^{[1
]}

Candoni, Anna ^{[10
,11
]}

Irrera, Giuseppe ^{[12
]}

Milone, Giuseppe ^{[13
,14
]}

Marcacci, Giampaolo ^{[15
]}

Scime, Rosanna ^{[16
]}

Musso, Maurizio ^{[17
]}

Cudillo, Laura ^{[18
]}

Sica, Simona ^{[19
]}

Castagna, Luca ^{[20
]}

Corradini, Paolo ^{[21
]}

Marchesi, Francesco ^{[22
]}

Pastore, Domenico ^{[23
]}

Alessandrino, Emilio Paolo ^{[24
]}

Annaloro, Claudio ^{[25
]}

Ciceri, Fabio ^{[26
]}

Santarone, Stella ^{[27
]}

Nassi, Luca ^{[28
]}

Farina, Claudio ^{[29
]}

Viscoli, Claudio ^{[30
]}

Rossolini, Gian Maria ^{[31
,32
]}

Bonifazi, Francesca ^{[33
]}

Rambaldi, Alessandro ^{[5
,34
]}

机构：

[1] Sapienza Univ Rome, Azienda Policlin Umberto 1, Dipartimento Ematol Oncol & Dermatol, Via Benevento 8, I-00161 Rome, Italy

[2] Osped Pediat Bambino Gesu, Unita Operat Oncoematol, Rome, Italy

[3] Fdn GIMEMA, Rome, Italy

[4] Osped Santa Maria Misericordia, Struttura Complessa Ematol Trapianto, Perugia, Italy

[5] ASST Papa Giovanni XXIII, Div Ematol, Bergamo, Italy

[6] PO Molinette, Dipartimento Oncol & Ematol AO Citta Salute & Sci, Turin, Italy

[7] Azienda Spedali Civili, Unita Operat Ematol, Brescia, Italy

[8] Osped Policlin San Martino, Ematol & Trapianto Midollo, Genoa, Italy

[9] Azienda Osped Univ Careggi, Cattedra Ematol, Florence, Italy

[10] Azienda Osped Univ, Clin Ematol, Udine, Italy

[11] Azienda Osped Univ, Unita Terapie Cellulari Carlo Melzi, Udine, Italy

[12] A Neri Osped Bianchi Melacrino Morelli, Div Ematol Ctr Unico Reg TMO & Terapie Ematooncol, Reggio Di Calabria, Italy

[13] Azienda Policlin Vittorio Emanuele Catania, Div Ematol, Catania, Italy

[14] Azienda Policlin Vittorio Emanuele Catania, Programma Trapianto Emopoiet, Catania, Italy

[15] IRCCS, UOC Ematol Oncol & Trapianto Cellule Staminali, Ist Nazl Tumori, Dipartimento Ematol,Fdn G Pascale, Naples, Italy

[16] AO Osped Riuniti Villa Sofia Cervello, UOC Ematol, Palermo, Italy

[17] Casa Cura La Maddalena, UO Oncoematol & TMO, Palermo, Italy

[18] Univ Tor Vergata, Fdn Policlin Tor Vergata, Unita Trapianto Cellule Staminali, Rome, Italy

[19] Univ Cattolica S Cuore, Policlin A Gemelli, Ist Ematol, Div Ematol, Rome, Italy

[20] Humanitas Res, Humanitas Canc Ctr, Rozzano, Italy

[21] Univ Milan, Fdn IRCCS Ist Nazl Tumori, Milan, Italy

[22] Ist Nazl Tumori Regina Elena IFO, UOSD Ematol & Trapianti, Rome, Italy

[23] Univ Bari, Dipartimento Emergenza & Trapianto Organo, Ematol Trapianto, Bari, Italy

[24] Fdn IRCCS Policlin San Matteo, Dipartimento Oncoematol, UOC Ematol, Pavia, Italy

[25] Osped Maggiore Policlin, Fdn IRCCS Ca Granda, Ctr Trapianti Midollo, Milan, Italy

[26] Osped San Raffaele, Unita Operat Ematol & Trapianto Midollo Osseo, Milan, Italy

[27] Osped Spirito Santo, UOC Trapianto Emopoiet, Pescara, Italy

[28] AOU Maggiore Carita, SCDU Ematol, Novara, Italy

[29] Azienda Osped ASST Papa Giovanni XXIII, UOC Microbiol & Virol, Bergamo, Italy

[30] Univ Genoa, Infect Dis Unit, IRCCS AOU San Martino IST, Genoa, Italy

[31] Univ Florence, Dipartimento Med Sperimentale & Clin, Florence, Italy

[32] Azienda Osped Univ Careggi, SOD Microbiol & Virol, Florence, Italy

[33] Policlin S Orsola Malpigli, Ist Ematol & Oncol Med LeA Seragnoli, Bologna, Italy

[34] Univ Milan, Dipartimento Oncol, Milan, Italy

来源：

CLINICAL INFECTIOUS DISEASES | 2017年 / 65卷 / 11期

关键词：

stem cell transplant; Gram negative bacteremia; multidrug resistance; epidemiology; survival; BLOOD-STREAM INFECTIONS; RESISTANT KLEBSIELLA-PNEUMONIAE; 4TH EUROPEAN CONFERENCE; ANTIMICROBIAL RESISTANCE; BACTERIAL-INFECTIONS; NEUTROPENIC PATIENTS; RECIPIENTS; EPIDEMIOLOGY; GUIDELINES; MORTALITY;

D O I：

10.1093/cid/cix690

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

In a prospective study in allogeneic and autologous hematopoietic stem cell transplants the probability of pre-engraftment Gram-negative bacteremia was 17.3% and 9%, respectively. Colonization by resistant Gram-negative bacteria was predictive of bacteremia and Gram-negative bacteremia was associated with increased mortality.Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. 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. 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). 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. NCT02088840.

引用

页码：1884 / 1896

页数：13

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