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, Alice Bertaina, Alfonso Piciocchi, Katia Perruccio, Alessandra Algarotti, Alessandro Busca, Chiara Cattaneo, Anna Maria Raiola, Stefano Guidi, Anna Paola Iori, Anna Candoni, Giuseppe Irrera, Giuseppe Milone, Giampaolo Marcacci, Rosanna Scimè, Maurizio Musso, Laura Cudillo, Simona Sica, Luca Castagna, Luigi CastagnaPaolo Corradini, Francesco Marchesi, Domenico Pastore, Emilio Paolo Alessandrino, Claudio Annaloro, Fabio Ciceri, Stella Santarone, Luca Nassi, Claudio Farina, Claudio Viscoli, Gian Maria Rossolini, Francesca Bonifazi, Alessandro Rambaldi, Saveria Capria, Angela Mastronuzzi, Daria Pagliara, Paola Bernaschi, Lucia Amico, Alessandra Carotti, Antonella Mencacci, Benedetto Bruno, Brunella Bruno, Cristina Costa, Angela Passi, Giuseppe Ravizzola, Emanuele Angelucci, Anna Marchese, Alessandra Maria Marchese, Patrizia Pecile, Giovanna Ventura, Giulio Ventura, Renato Fanin, Claudio Scarparo, Angelo Barbaro, Salvatore Leotta, Salvatore Nuccio Leotta, Anna Elisa Marchese, Cristina Becchimanzi, Daniela Donnarumma, Stefania Tringali, Maria Teresa Baldi, Renato Scalone, Alessandra Picardi, William Arcese, Carla Fontana, Cecilia Alejandra Fontana, Sabrina Giammarco, Teresa Spanu, Roberto Crocchiolo, Erminia Casari, Alberto Mussetti, Eutilia Conte, Eliana Conte, Fabrizio Ensoli, Giuseppe Miragliotta, Piero Marone, Milena Arghittu, Raffaella Greco, Alessandra Forcina, Paola Chichero, Paolo Di Bartolomeo, Paolo Fazii, Vesselina Kroumova, Nunzia Decembrino, Marco Zecca, Giovanni Pisapia, Giulia Palazzo, Edoardo Lanino, Maura Faraci, Elio Castagnola, Roberto Bandettini, Rocco Pastano, Simona Sammassimo, Rita Passerini, Piero Maria Stefani, Filippo Gherlinzoni, Roberto Rigoli, Lucia Prezioso, Benedetta Cambò, Adriana Calderaro, Angelo Michele Carella, Nicola Cascavilla, Maria Teresa Labonia, Ivana Celeghini, Nicola Mordini, Federica Piana, Adriana Vacca, Marco Sanna, Maria Maddalena Sanna, Giovanni Podda, Maria Teresa Corsetti, Andrea Rocchetti, Daniela Cilloni, Marco De Gobbi, Ornella Bianco, Franca Fagioli, Francesca Carraro, Gianfranco De Intinis, Alessandro Severino, Anna Proia, Anna Silvia Proia, Gabriella Parisi, Daniele Vallisa, Massimo Confalonieri, Marco Confalonieri, Domenico Russo, Michele Malagola, Piero Galieni, Sadia Falcioni, Valeria Travaglini, Roberto Raimondi, Maria Rosa Raimondi, Carlo Borghero, Giacomina Pavan, Giuseppe Pavan, Arcangelo Prete, Tamara Belotti, Simone Ambretti, Manuela Imola, Anna Maria Mianulli, Maria Federica Pedna, Simone Cesaro, Giuliana Lo Cascio, Antonella Ferrari, Monica Piedimonte, Iolanda Santino, Monica Calandrelli, Attilio Olivieri, Alessandra Olivieri, Francesca Orecchioni, Milena Mirabile, Riccardo Centurioni, Luciana Gironacci, Daniela Caravelli, Susanna Gallo, Marco De Filippi, Luca Cupelli, Teresa Dentamaro, Silvana Falco, Ospedale S Eugenio, Serena Marotta, Antonio Risitano, Dora Lula, Pellegrino Musto, Giuseppe Pietrantuono, Antonio Traficante, Elisabetta Cerchiara, Maria Cristina Tirindelli, Giordano Dicuonzo, Anna Chierichini, Barbara Anaclerico, Paola Placanica

Risultato della ricerca: Contributo in rivistaArticolo in rivista

45 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)1884-1896
Numero di pagine13
RivistaClinical Infectious Diseases
Volume65
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Bacteremia
  • Child
  • Child, Preschool
  • Drug Resistance, Multiple, Bacterial
  • Escherichia coli
  • Female
  • Gram negative bacteremia
  • Gram-Negative Bacteria
  • Gram-Negative Bacterial Infections
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Incidence
  • Infant
  • Italy
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Transplantation Conditioning
  • Transplantation, Autologous
  • Transplantation, Homologous
  • Young Adult
  • epidemiology
  • multidrug resistance
  • stem cell transplant
  • survival

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