Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome.
Unità Operativa di Oncoematologia, Ospedale pediatrico Bambino Gesù.
Clin Infect Dis. 2017 Nov 13;65(11):1884-1896. doi: 10.1093/cid/cix690.
Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable.
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.
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).
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.
NCT02088840.
革兰氏阴性菌血症（GNB）是造血干细胞移植（HSCT）后发病和死亡的主要原因，因此有必要进行最新的流行病学调查。
我们前瞻性评估了 54 个移植中心在 2014 年进行的 1118 例异基因 HSCT（allo-HSCT）和 1625 例自体 HSCT（auto-HSCT）中植入前 GNB 的流行病学。使用逻辑回归方法，我们确定了 GNB 的危险因素，并评估了 GNB 对移植后 4 个月总生存率的影响。
allo-HSCT 中植入前 GNB 的累积发生率为 17.3%，auto-HSCT 中为 9%。大肠杆菌、肺炎克雷伯菌和铜绿假单胞菌是最常见的分离株。多变量分析显示，与 GNB 相关的变量包括急性白血病诊断、HLA mismatched 供体和脐带血供体、年龄较大、allo-HSCT 中严重中性粒细胞减少时间较长，以及淋巴瘤诊断、年龄较大、auto-HSCT 中无抗菌预防。移植前耐药病原体感染与 allo-HSCT 后同种微生物感染的风险增加显著相关。在两种移植程序中，耐药革兰氏阴性菌定植与同种病原体感染率增加显著相关。GNB 与 allo-HSCT（危险比，2.13；95%置信区间，1.45-3.13；P<.001）和 auto-HSCT（2.43；1.22-4.84；P=.01）的 4 个月死亡率增加独立相关。
植入前 GNB 是影响 auto-HSCT 和 allo-HSCT 后 4 个月死亡率的独立因素。既往感染史和定植监测是 GNB 的主要指标。
NCT02088840。
