Peking University People's Hospital, Peking University Institute of Hematology, Beijing, 100044, China.
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
Front Med. 2019 Aug;13(4):492-503. doi: 10.1007/s11684-019-0681-0. Epub 2019 Apr 4.
We aimed to identify the effect of positive stool cultures (PSCs) on the clinical outcomes of patients undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT) (n = 332). PSCs were observed in 61 patients (PSC group, 18.4%). Enterobacteriaceae in stool specimens was associated with a higher risk of bloodstream infection, and Candida in stool specimens was related to a higher risk of platelet engraftment failure. The cumulative incidence of infection-related mortality 1 year after haplo-HSCT in the PSC group was higher than that of the patients who showed persistently negative stool cultures (NSC group; 19.2% vs. 8.9%, P = 0.017). The probabilities of overall survival (71.4% vs. 83.8%, P = 0.031) and disease-free survival (69.6% vs. 81.0%, P = 0.048) 1 year after haplo-HSCT for the PSC group were significantly lower than those for the NSC group, particularly for patients who had Candida in their stool specimens. In multivariate analysis, Candida in stool specimens significantly increased the risk of mortality and was associated with poorer survival. Our results showed that PSC influenced the clinical outcomes after haplo-HSCT, particularly those who had Candida in their stool specimens.
我们旨在确定阳性粪便培养（PSC）对接受单倍体造血干细胞移植（haplo-HSCT）的患者临床结局的影响（n=332）。在 61 名患者中观察到 PSC（PSC 组，18.4%）。粪便标本中的肠杆菌科与血流感染风险增加相关，而粪便标本中的念珠菌与血小板植入失败风险增加相关。haplo-HSCT 后 1 年时，PSC 组感染相关死亡率的累积发生率高于持续粪便培养阴性（NSC 组）的患者（19.2% vs. 8.9%，P=0.017）。haplo-HSCT 后 1 年时，PSC 组的总生存率（71.4% vs. 83.8%，P=0.031）和无病生存率（69.6% vs. 81.0%，P=0.048）显著低于 NSC 组，特别是粪便标本中存在念珠菌的患者。多变量分析显示，粪便标本中的念珠菌显著增加了死亡风险，与生存不良相关。我们的研究结果表明，PSC 影响了 haplo-HSCT 后的临床结局，特别是粪便标本中存在念珠菌的患者。
