Kikuchi M, Akahoshi Y, Nakano H, Ugai T, Wada H, Yamasaki R, Sakamoto K, Kawamura K, Ishihara Y, Sato M, Ashizawa M, Terasako-Saito K, Kimura S, Yamazaki R, Kanda J, Kako S, Nishida J, Kanda Y
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Transpl Infect Dis. 2015 Feb;17(1):56-65. doi: 10.1111/tid.12345. Epub 2015 Jan 12.
Bloodstream infections (BSI) are frequently observed after allogeneic hematopoietic stem cell transplant (HSCT), and could cause morbidity and mortality.
We retrospectively evaluated the incidence, characteristics of, and risk factors for BSI at both pre- and post-engraftment in 209 adult HSCT patients at our institute between June 2006 and December 2013. The median age at transplantation was 45 years (range, 15-65). A total of 122 patients received bone marrow, 68 received peripheral blood stem cells, and 19 received umbilical cord blood.
The cumulative incidences of pre- and post-engraftment BSI were 38.9% and 17.2%, respectively. Nine patients had both pre- and post-engraftment BSI. In the pre- and post-engraftment periods, respectively, 67.4% and 84.1% of isolates were gram-positive bacteria (GPB), 28.3% and 11.4% were gram-negative bacteria (GNB), and 4.3% and 4.5% were fungi. Coagulase-negative staphylococci were the most commonly isolated GPB, while Stenotrophomonas maltophilia and Pseudomonas aeruginosa were the most commonly isolated GNB. Pre-engraftment BSI was associated with an increased risk of death. Overall survival at day 180 for patients with or without pre-engraftment BSI was 70.0% and 82.7%, respectively (P = 0.02).
Risk factors for BSI in the pre-engraftment period were the interval between diagnosis and transplantation (261 days or more), engraftment failure, and high-risk disease status at HSCT in a multivariate analysis. No significant risk factor for BSI in the post-engraftment period was identified by a univariate analysis. These findings may be useful for deciding upon empiric antibacterial treatment for HSCT recipients.
异基因造血干细胞移植（HSCT）后经常观察到血流感染（BSI），其可导致发病和死亡。
我们回顾性评估了2006年6月至2013年12月期间我院209例成年HSCT患者移植前和移植后BSI的发生率、特征及危险因素。移植时的中位年龄为45岁（范围15 - 65岁）。共有122例患者接受骨髓移植，68例接受外周血干细胞移植，19例接受脐带血移植。
移植前和移植后BSI的累积发生率分别为38.9%和17.2%。9例患者移植前和移植后均发生BSI。在移植前和移植后阶段，分离株分别有67.4%和84.1%为革兰氏阳性菌（GPB），28.3%和11.4%为革兰氏阴性菌（GNB），4.3%和4.5%为真菌。凝固酶阴性葡萄球菌是最常分离出的GPB，而嗜麦芽窄食单胞菌和铜绿假单胞菌是最常分离出的GNB。移植前BSI与死亡风险增加相关。有或无移植前BSI患者在第180天的总生存率分别为70.0%和82.7%（P = 0.02）。
多因素分析显示，移植前期BSI的危险因素为诊断与移植之间的间隔时间（261天或更长）、植入失败以及HSCT时的高危疾病状态。单因素分析未发现移植后期BSI的显著危险因素。这些发现可能有助于为HSCT受者决定经验性抗菌治疗方案。
