Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation
Background. Bloodstream infections (BSI) are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The objective of study was to analyze pre- and post-engraftment BSI.Materials and methods. From January 2018 till May 2021242 patients after first allo-HSCT were enrolled in the...
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| Format: | Article |
| Language: | Russian |
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ABV-press
2022-01-01
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| Series: | Онкогематология |
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| Online Access: | https://oncohematology.abvpress.ru/ongm/article/view/527 |
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| author | M. I. Akhmedov G. A. Klyasova E. N. Parovichnikova L. A. Kuzmina A. V. Fedorova V. A. Vasil’eva M. Yu. Drokov S. M. Kulikov V. G. Savchenko |
| author_facet | M. I. Akhmedov G. A. Klyasova E. N. Parovichnikova L. A. Kuzmina A. V. Fedorova V. A. Vasil’eva M. Yu. Drokov S. M. Kulikov V. G. Savchenko |
| author_sort | M. I. Akhmedov |
| collection | DOAJ |
| description | Background. Bloodstream infections (BSI) are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The objective of study was to analyze pre- and post-engraftment BSI.Materials and methods. From January 2018 till May 2021242 patients after first allo-HSCT were enrolled in the study. Median age was 35 (17–65) years. The majority of transplants were done for acute leukemias (71.9 %) in remission (91.7 %) with reduced-intensity conditioning regimens (71.5 %) and peripheral blood stem cells (74.4 %) as a graft source.Results. Of 242 patients 95 (39.2 %) developed BSI: 79 (83.2 %) developed 1 BSI episode, 16 (16.8 %) – 2 or more. Overall 113 BSI episodes were registered: 94 (82.7 %) were caused by single microorganism, 19 (17.3 %) were polymicrobial. Probability of pre-engraftment BSI was 31.0 %, post-engraftment – 11.8 %. In total 134 microorganisms were identified: 61.2 % – gram-negative and 38.8 % – gram-positive bacteria. Gram-negative BSI rate was significantly higher during post-engraftment compared to pre-engraftment phase (57.7 % vs. 70.3 %; р = 0.008). Major risk factor for pre-engraftment BSI was mismatched unrelated allo-HSCTs (hazard ratio (HR) 2.55; 95 % confidence interval (CI) 1.32–4.91; р = 0.03), for post-engraftment BSI – secondary poor graft function (HR 21.70; 95 % CI 7.95–59.24; р <0.0001) and graft failure (HR 21.55; 95 % CI 6.27–74.08; р <0.0001), and gut graft-versus-host disease (HR 12.90; 95 % CI 5.77–28.80; р <0.0001). Thirty-day survival after each BSI episode was 90.3 % and was significantly lower in patients with post-engraftment BSI compared to pre-engraftment (71.9 % vs. 97.5 %; р <0.0001).Conclusion. Gram-negative bacteria prevailed in the etiology of BSI. The main risk factors for pre-engraftment BSI was allo-HSCT from mismatched unrelated donors, for post-engraftment BSI – secondary poor graft function and graft failure. Post-engraftment BSI is associated with worse prognosis. |
| first_indexed | 2024-04-09T20:24:47Z |
| format | Article |
| id | doaj.art-e6b1b47c70ec4a96b6e0418b270b5a19 |
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| issn | 1818-8346 2413-4023 |
| language | Russian |
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| series | Онкогематология |
| spelling | doaj.art-e6b1b47c70ec4a96b6e0418b270b5a192023-03-30T20:15:14ZrusABV-pressОнкогематология1818-83462413-40232022-01-0117112113410.17650/1818-8346-2022-17-1-121-134430Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantationM. I. Akhmedov0G. A. Klyasova1E. N. Parovichnikova2L. A. Kuzmina3A. V. Fedorova4V. A. Vasil’eva5M. Yu. Drokov6S. M. Kulikov7V. G. Savchenko8National Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaNational Medical Research Center for Hematology, Ministry of Health of RussiaBackground. Bloodstream infections (BSI) are common after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The objective of study was to analyze pre- and post-engraftment BSI.Materials and methods. From January 2018 till May 2021242 patients after first allo-HSCT were enrolled in the study. Median age was 35 (17–65) years. The majority of transplants were done for acute leukemias (71.9 %) in remission (91.7 %) with reduced-intensity conditioning regimens (71.5 %) and peripheral blood stem cells (74.4 %) as a graft source.Results. Of 242 patients 95 (39.2 %) developed BSI: 79 (83.2 %) developed 1 BSI episode, 16 (16.8 %) – 2 or more. Overall 113 BSI episodes were registered: 94 (82.7 %) were caused by single microorganism, 19 (17.3 %) were polymicrobial. Probability of pre-engraftment BSI was 31.0 %, post-engraftment – 11.8 %. In total 134 microorganisms were identified: 61.2 % – gram-negative and 38.8 % – gram-positive bacteria. Gram-negative BSI rate was significantly higher during post-engraftment compared to pre-engraftment phase (57.7 % vs. 70.3 %; р = 0.008). Major risk factor for pre-engraftment BSI was mismatched unrelated allo-HSCTs (hazard ratio (HR) 2.55; 95 % confidence interval (CI) 1.32–4.91; р = 0.03), for post-engraftment BSI – secondary poor graft function (HR 21.70; 95 % CI 7.95–59.24; р <0.0001) and graft failure (HR 21.55; 95 % CI 6.27–74.08; р <0.0001), and gut graft-versus-host disease (HR 12.90; 95 % CI 5.77–28.80; р <0.0001). Thirty-day survival after each BSI episode was 90.3 % and was significantly lower in patients with post-engraftment BSI compared to pre-engraftment (71.9 % vs. 97.5 %; р <0.0001).Conclusion. Gram-negative bacteria prevailed in the etiology of BSI. The main risk factors for pre-engraftment BSI was allo-HSCT from mismatched unrelated donors, for post-engraftment BSI – secondary poor graft function and graft failure. Post-engraftment BSI is associated with worse prognosis.https://oncohematology.abvpress.ru/ongm/article/view/527bloodstream infectionsbacteriemiaallogeneic hematopoietic stem cell transplantationrisk factor |
| spellingShingle | M. I. Akhmedov G. A. Klyasova E. N. Parovichnikova L. A. Kuzmina A. V. Fedorova V. A. Vasil’eva M. Yu. Drokov S. M. Kulikov V. G. Savchenko Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation Онкогематология bloodstream infections bacteriemia allogeneic hematopoietic stem cell transplantation risk factor |
| title | Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| title_full | Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| title_fullStr | Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| title_full_unstemmed | Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| title_short | Bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| title_sort | bloodstream infections in different stage of reconstitution after first allogeneic hematopoietic stem cell transplantation |
| topic | bloodstream infections bacteriemia allogeneic hematopoietic stem cell transplantation risk factor |
| url | https://oncohematology.abvpress.ru/ongm/article/view/527 |
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