Intercontinental study on pre-engraftment and post-engraftment Gram-negative rods bacteremia in hematopoietic stem cell transplantation patients: Risk factors and association with mortality.
J Infect
; 81(6): 882-894, 2020 12.
Article
em En
| MEDLINE
| ID: mdl-33186673
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Bacteriemia
/
Transplante de Células-Tronco Hematopoéticas
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
País como assunto:
Asia
/
Europa
/
Oceania
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article