The incidence, risk factors and outcomes of early bloodstream infection in patients with malignant hematologic disease after unrelated cord blood transplantation: a retrospective study
Tóm tắt
Bloodstream infection (BSI) is one of the major causes of morbidity and mortality for patients undergoing hematopoietic stem cell transplantation (HSCT). The unrelated cord blood transplantation (UCBT) can provided opportunities for patients without suitable donors for bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT), while few studies have addressed BSI after UCBT. The aim of this study was to analyse the incidence and risk factors of BSI, causative organisms, microbial resistance, and its impact on the clinical outcomes and survival of patients. There are 336 patients, were divided into two groups depending on whether developing BSI. Demographic characteristics, laboratory data, and clinical outcome were compared between different groups. The risk factors of BSI was examined using logistic regression and the survival was examined using the Kaplan-Meier method and log-rank test. Ninety-two patients (27.4%) developed early BSI with 101 pathogenic bacteria isolated, and the median day of developing initial BSI was 4.5 d. Gram-negative bacteria were the most common isolate (60, 59.4%), followed by Gram-positive bacteria (40, 39.6%) and fungi (1, 1.0%). Thirty-seven (36.6%) isolates were documented as having multiple drug resistance (MDR). Myeloid malignancies, conditioning regimens including total body irradiation (TBI), and prolonged neutropenia were identified as the independent risk factors for early BSI. The 3-year OS was 59.9% versus 69.2% in the BSI group and no-BSI group (P = 0.0574), respectively. The 3-year OS of the MDR group was significantly lower than that of the non-BSI group (51.1% versus 69.2%, p = 0.013). Our data indicate that the incidence of early BSI after UCBT was high, especially in patients with myeloid disease and a conditioning regimen including TBI and prolonged neutropenia. Early BSI with MDR after UCBT had a negative impact on long-term survival.
Tài liệu tham khảo
Sanz J, Cano I, Gonzalez-Barbera EM, Arango M, Reyes J, Montesinos P, et al. Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen. Biol Blood Marrow Transplant. 2015;21:755–60.
Rocha V, Labopin M, Sanz G, Arcese W, Schwerdtfeger R, Bosi A, et al. Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia. N Engl J Med. 2004;351:2276–85.
Laughlin MJ, Eapen M, Rubinstein P, Wagner JE, Zhang MJ, Champlin RE, et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med. 2004;351:2265–75.
Yazaki M, Atsuta Y, Kato K, Kato S, Taniguchi S, Takahashi S, et al. Incidence and risk factors of early bacterial infections after unrelated cord blood transplantation. Biol Blood Marrow Transplant. 2009;15:439–46.
Narimatsu H, Matsumura T, Kami M, Miyakoshi S, Kusumi E, Takagi S, et al. Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients. Biol Blood Marrow Transplant. 2005;11:429–36.
Tomonari A, Takahashi S, Ooi J, Tsukada N, Konuma T, Kobayashi T, et al. Bacterial bloodstream infection in neutropenic adult patients after myeloablative cord blood transplantation: experience of a single institution in Japan. Int J Hematol. 2007;85:238–41.
Kobayashi R, Yabe H, Kikuchi A, Kudo K, Yoshida N, Watanabe K, et al. Bloodstream infection after stem cell transplantation in children with idiopathic aplastic anemia. Biol Blood Marrow Transplant. 2014;20:1145–9.
Gudiol C, Garcia-Vidal C, Arnan M, Sanchez-Ortega I, Patino B, Duarte R, et al. Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients. Bone Marrow Transplant. 2014;49:824–30.
Cappellano P, Viscoli C, Bruzzi P, Van Lint MT, Pereira CA, Bacigalupo A. Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion. New Microbiol. 2007;30:89–99.
Frere P, Hermanne JP, Debouge MH, de Mol P, Fillet G, Beguin Y. Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures. Bone Marrow Transplant. 2004;33:745–9.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.
Saavedra S, Sanz GF, Jarque I, Moscardo F, Jimenez C, Lorenzo I, et al. Early infections in adult patients undergoing unrelated donor cord blood transplantation. Bone Marrow Transplant. 2002;30:937–43.
Barker JN, Hough RE, Van Burik JA, DeFor TE, MacMillan ML, O'Brien MR, et al. Serious infections after unrelated donor transplantation in 136 children: impact of stem cell source. Biol Blood Marrow Transplant. 2005;11:362–70.
Montoro J, Piñana JL, Moscardó F, Sanz J. Infectious complications after umbilical cord-blood transplantation from unrelated donors. Mediterr J Hematol Infect Dis. 2016;8:e2016051.
Szabolcs P. T lymphocyte recovery and function after cord blood transplantation. Immunol Res. 2011;49:56–69.
Zhang L, Lu H, Liu H, Zhu X, Tang B, Zheng C. Pathogens and clinical characteristics of bacterial infection in hematology department between 2010 and 2014. Chin J Hematol. 2016;37:383–7.
Samonis G, Vardakas KZ, Maraki S, Tansarli GS, Dimopoulou D, Kofteridis DP, et al. A prospective study of characteristics and outcomes of bacteremia in patients with solid organ or hematologic malignancies. Support Care Cancer. 2013;21:2521–6.
Han TT, Huang XJ, Liu KY, Liu DH, Chen H, Han W, et al. Blood stream infections during agranulocytosis period after hematopoietic stem cell transplantation in one single center. Zhonghua Nei Ke Za Zhi. 2011;50:654–8.
Wang L, Wang Y, Fan X, Tang W, Hu J. Prevalence of resistant gram-negative bacilli in bloodstream infection in febrile neutropenia patients undergoing hematopoietic stem cell transplantation: a single center retrospective cohort study. Medicine. 2015;94:e1931.
Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR. Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant. 2007;40:63–70.
Satlin MJ, Calfee DP, Chen L, Fauntleroy KA, Wilson SJ, Jenkins SG. Emergence of carbapenem-resistant Enterobacteriaceae as causes of bloodstream infections in patients with hematologic malignancies[I]. Leuk Lymphoma. 2013;54(4):799–806.
Keng MK, Sekeres MA. Febrile neutropenia in hematologic malignancies. Curr Hematol Malig Rep. 2013;8:370–8.
Ram R, Yeshurun M, Farbman L, Herscovici C, Shpilberg O, Paul M. Elevation of CRP precedes clinical suspicion of bloodstream infections in patients undergoing hematopoietic cell transplantation. J Inf Secur. 2013;67:194–8.
Trecarichi EM, Tumbarello M, Caira M, Candoni A, Cattaneo C, Pastore D, et al. Multidrug resistant Pseudomonas aeruginosa bloodstream infection in adult patients with hematologic malignancies. Haematologica. 2011;96:e1–3.
Stoma I, Karpov I, Milanovich N, Uss A, Iskrov I. Risk factors for mortality in patients with bloodstream infections during the pre-engraftment period after hematopoietic stem cell transplantation. Blood Res. 2016;51:102–6.
Taur Y, Jenq RR, Perales MA, Littmann ER, Morjaria S, Ling L, et al. The effects of intestinal tract bacterial diversity on mortality following allogeneic hematopoietic stem cell transplantation. Blood. 2014;124:1174–82.
Josefsdottir KS, Baldridge MT, Kadmon CS, King KY. Antibiotics impair murine hematopoiesis by depleting the intestinal microbiota. Blood. 2017;129:729–39.