Intercontinental study on pre-engraftment and post-engraftment Gram-negative rods bacteremia in hematopoietic stem cell transplantation patients: Risk factors and association with mortality

• Published in: The Journal of infection Vol. 81; no. 6; pp. 882 - 894
• Main Authors: Averbuch, Diana, Tridello, Gloria, Hoek, Jennifer, Mikulska, Malgorzata, Pabst, Thomas, Yaňez San Segundo, Lucrecia, Akan, Hamdi, Özçelik, Tülay, Donnini, Irene, Klyasova, Galina, Botelho de Sousa, Aida, Zuckerman, Tsila, Tecchio, Cristina, de la Camara, Rafael, Aki, Sahika Zeynep, Ljungman, Per, Gülbas, Zafer, Nicolas-Virelizier, Emmanuelle, Calore, Elisabetta, Perruccio, Katia, Ram, Ron, Annaloro, Claudio, Martino, Rodrigo, Avni, Batia, Shaw, Peter J., Jungova, Alexandra, Codeluppi, Katia, O'Brien, Tracey, Waszczuk-Gajda, Anna, Batlle, Montserrat, Pouli, Anastasia, Lueck, Catherina, Gil, Lidia, Iacobelli, Simona, Styczynski, Jan, Engelhard, Dan, Cesaro, Simone
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2020
• Subjects: Aged; Asia; Australia; Bacteremia; Bacteremia - epidemiology; Europe - epidemiology; Europe, Eastern; Fluoroquinolone prophylaxis; Gram-negative; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Medicin och hälsovetenskap; Mortality; Post-engraftment; Pre-engraftment; Prospective Studies; Retrospective Studies; Risk Factors; Stem cell transplantation; Transplantation, Homologous; Europe, Eastern; Australia; Asia; Europe; Gram-negative; Mortality; Pre-engraftment; Post-engraftment; Stem cell transplantation; Bacteremia; Risk factors; Fluoroquinolone prophylaxis
• ISSN: 0163-4453; 1532-2742; 1532-2742
• DOI: 10.1016/j.jinf.2020.11.002

•Center` fluoroquinolone prophylaxis allo-HSCT policy does not influence pre-engraftment Gram-negative rods bacteremia (GNRB) rate.•Low post-engraftment GNRB rate in allo-HSCT patients in JACIE/FACT-accredited centers.•High pre-engraftment GNRB rate in auto-HSCT patients with autoimmune diseases.•Low pre-engraftment GNRB rate in auto-HSCT centers with active infection control team.•MDR GNRB associated with increased post-HSCT mortality. We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. 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). 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. 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.