Background. Gram negative bacterial infections (GNBI) are a major cause of morbidity and mortality in Hematopoietic Stem Cell Transplant (HSCT) and updated epidemiological investigation is advisable. Methods. We prospectively evaluated the epidemiology of pre-engraftment GNBI in 1,118 allogeneic HSCT (allo-HSCT) and 1,625 autologous HSCT (auto-HSCT) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods we identified risk factors for GNBI and evaluated the impact of GNBI on the 4-month overall-survival after transplant. SIGNB-GITMO-AMCLI is registered with ClinicalTrials.gov, number NCT02088840. Findings The cumulative incidence of GNBIs was 18.6% in allo-HSCT and 10% in auto-HSCT. E. coli, K. pneumoniae and P. aeruginosa were the most common isolates. By multivariate analysis variables associated with pre-engraftment GNBI were a diagnosis of acute leukemia, a transplant from 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 pre-transplant infection by a resistant pathogen was significantly associated to an increased risk of post-transplant infection by the same microorganism in allo-HSCT. Colonization by resistant Gram-negative bacteria was significantly associated to an increased risk of preengraftment infection by the same pathogen in both transplant procedures. GNBIs were independently associated to increased mortality at 4-months from transplant both in allo-HSCT (HR 2.08, 95% CI 1.43-3.04; p=.0001) and auto-HSCT (HR 2.52, 95% CI 1.28-4.99; p=.008). Interpretation. Pre-engraftment GNBIs are a major cause of morbidity and mortality in auto- HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNBI.
Incidence, risk factors and outcome of pre engraftment Gram negative bacterial infections after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey / Girmenia, Corrado; Bertaina, Alice; Piciocchi, Alfonso; Perruccio, Katia; Algarotti, Alessandra; Busca, Alessandro; Cattaneo, Chiara; Maria Raiola, Anna; Guidi, Stefano; Iori, ANNA PAOLA; Candoni, Anna; Irrera, Giuseppe; Milone, Giuseppe; Marcacci, Giampaolo; Scimè, Rosanna; Musso, Maurizio; Cudillo, Laura; Sica, Simona; Castagna, Luca; Corradini, Paolo; Marchesi, Francesco; Pastore, Domenico; Paolo Alessandrino, Emilio; Annaloro, Claudio; Ciceri, Fabio; Santarone, Stella; Nassi, Luca; Farina, Claudio; Viscoli, Claudio; Maria Rossolini, Gian; Bonifazi, Francesca; Rambaldi, Alessandro; Collaborators: Saveria Capria, Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI).; Bertaina, A; Mastronuzzi, Angela; Pagliara, Daria; Bernaschi, Paola; Amico, Lucia; Carotti, Alessandra; Mencacci, Antonella; Busca, A; Bruno, Benedetto; Costa, Cristina; Passi, Angela; Ravizzola, Giuseppe; Angelucci, Emanuele; Marchese, Anna; Pecile, Patrizia; Candoni, A; Ventura, Giovanna; Fanin, Renato; Scarparo, Claudio; Barbaro, Angelo; Milone, G; Leotta, Salvatore; Elisa Marchese, Anna; Marcacci, G; Becchimanzi, Cristina; Donnarumma, Daniela; Tringali, Stefania; Teresa Baldi, Maria; Scalone, Renato; Teresa Baldi, Maria; Cudillo, L; Picardi, Alessandra; Arcese, William; Fontana, Carla; Sica, S; Giammarco, Sabrina; Spanu, Teresa; Castagna, L; Crocchiolo, Roberto; Casari, Erminia; Corradini, Paolo; Mussetti, Alberto; Conte, Eutilia; Ensoli, Fabrizio; Miragliotta, Giuseppe; Marone, Piero; Arghittu, Milena; Greco, Raffaella; Forcina, Alessandra; Chichero, Paola; Santarone, S; Di Bartolomeo, Paolo; Fazii, Paolo; Kroumova, Vesselina; Decembrino, Nunzia; Zecca, Marco; Marone, Piero; Pisapia, Giovanni; Palazzo, Giulia; Palazzo, Giulia; Lanino, Edoardo; Faraci, Maura; Castagnola, Elio; Bandettini, Roberto; Pastano, Rocco; Sammassimo, Simona; Passerini, Rita; Maria Stefani, Piero; Gherlinzoni, Filippo; Rigoli, Roberto; Prezioso, Lucia; Cambò, Benedetta; Calderaro, Adriana; Michele Carella, Angelo; Cascavilla, Nicola; Teresa Labonia, Maria; Celeghini, Ivana; Mordini, Nicola; Piana, Federica; Vacca, Adriana; Sanna, Marco; Podda, Giovanni; Corsetti, Maria Teresa; Rocchetti, Andrea; Cilloni, Daniela; De Gobbi, Marco; Bianco, Ornella; Fagioli, Franca; Carraro, Francesca; De Intinis, Gianfranco; Severino, Alessandro; Proia, Anna; Parisi, Gabriella; Vallisa, Daniele; Confalonieri, Massimo; Russo, Domenico; Malagola, Michele; Ravizzola, Giuseppe; Galieni, Piero; Falcioni, Sadia; Travaglini, Valeria; Raimondi, Roberto; Borghero, Carlo; Pavan, Giacomina; Prete, Arcangelo; Belotti, Tamara; Ambretti, Simone; Imola, Manuela; Maria Mianulli, Anna; Federica Pedna, Maria; Cesaro, Simone; Lo Cascio, Giuliana; Ferrari, Antonella; Piedimonte, Monica; Santino, Iolanda; Alandrelli, Monica; Olivieri, Attilio; Orecchioni, Francesca; Mirabile, Milena; Centurioni, Riccardo; Gironacci, Luciana; Caravelli, Daniela; Gallo, Susanna; De Filippi, Marco; Cupelli, Luca; Dentamaro, Teresa; Falco, Silvana; S Eugenio, Ospedale; Marotta, Serena; Risitano, Antonio; Lula, Dora; Musto, Pellegrino; Pietrantuono, Giuseppe; Traficante, Antonio. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - STAMPA. - 65:(2017), pp. 1884-1896. [10.1093/cid/cix690]
Incidence, risk factors and outcome of pre engraftment Gram negative bacterial infections after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey
Anna Paola Iori;Maria Teresa Corsetti;Monica Piedimonte;Iolanda Santino;
2017
Abstract
Background. Gram negative bacterial infections (GNBI) are a major cause of morbidity and mortality in Hematopoietic Stem Cell Transplant (HSCT) and updated epidemiological investigation is advisable. Methods. We prospectively evaluated the epidemiology of pre-engraftment GNBI in 1,118 allogeneic HSCT (allo-HSCT) and 1,625 autologous HSCT (auto-HSCT) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods we identified risk factors for GNBI and evaluated the impact of GNBI on the 4-month overall-survival after transplant. SIGNB-GITMO-AMCLI is registered with ClinicalTrials.gov, number NCT02088840. Findings The cumulative incidence of GNBIs was 18.6% in allo-HSCT and 10% in auto-HSCT. E. coli, K. pneumoniae and P. aeruginosa were the most common isolates. By multivariate analysis variables associated with pre-engraftment GNBI were a diagnosis of acute leukemia, a transplant from 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 pre-transplant infection by a resistant pathogen was significantly associated to an increased risk of post-transplant infection by the same microorganism in allo-HSCT. Colonization by resistant Gram-negative bacteria was significantly associated to an increased risk of preengraftment infection by the same pathogen in both transplant procedures. GNBIs were independently associated to increased mortality at 4-months from transplant both in allo-HSCT (HR 2.08, 95% CI 1.43-3.04; p=.0001) and auto-HSCT (HR 2.52, 95% CI 1.28-4.99; p=.008). Interpretation. Pre-engraftment GNBIs are a major cause of morbidity and mortality in auto- HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNBI.| File | Dimensione | Formato | |
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