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Clinical Trial
. 2017 Nov 13;65(11):1884-1896.
doi: 10.1093/cid/cix690.

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

Corrado Girmenia  1 , Alice Bertaina  2 , Alfonso Piciocchi  3 , Katia Perruccio  4 , Alessandra Algarotti  5 , Alessandro Busca  6 , Chiara Cattaneo  7 , Anna Maria Raiola  8 , Stefano Guidi  9 , Anna Paola Iori  1 , Anna Candoni  10 , Giuseppe Irrera  11 , Giuseppe Milone  12 , Giampaolo Marcacci  13 , Rosanna Scimè  14 , Maurizio Musso  15 , Laura Cudillo  16 , Simona Sica  17 , Luca Castagna  18 , Paolo Corradini  19 , Francesco Marchesi  20 , Domenico Pastore  21 , Emilio Paolo Alessandrino  22 , Claudio Annaloro  23 , Fabio Ciceri  24 , Stella Santarone  25 , Luca Nassi  26 , Claudio Farina  27 , Claudio Viscoli  28 , Gian Maria Rossolini  29   30 , Francesca Bonifazi  31 , Alessandro Rambaldi  5   32 ; Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI)
Collaborators, Affiliations
Free article
Clinical Trial

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

Corrado Girmenia et al. Clin Infect Dis. .
Free article

Abstract

Background: Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical trials registration: NCT02088840.

Keywords: Gram negative bacteremia; epidemiology; multidrug resistance; stem cell transplant; survival.

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