Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon.
Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon.
Infection. 2020 Jun;48(3):385-401. doi: 10.1007/s15010-020-01407-6. Epub 2020 Mar 13.
Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital.
This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks.
One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29-11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27-120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05-10.98), P = 0.04].
The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.
感染并发症是异基因造血细胞移植（allo-HCT）后发病率和死亡率的重要原因。它们在不同时期的发生情况各不相同，黎巴嫩和邻国的报告数据很少。在这项研究中，我们描述了在贝鲁特 Makassed 综合医院接受 allo-HCT 的患者在移植前中性粒细胞减少期、发热期和移植前医疗并发症。
这是一项对 2007 年至 2016 年间在黎巴嫩贝鲁特 Makassed 综合医院接受 allo-HCT 的患者进行的回顾性图表审查。数据从病历、HCT 登记处和医学实验室日志中提取。
共有 106 名患者入组，其中 75%患有血液系统恶性肿瘤，13%患有再生障碍性贫血。没有患者接受氟喹诺酮类药物的预防性抗菌治疗。然而，从预处理化疗到 HCT 前一天，由于发热或感染，32%的患者接受了广谱抗生素（BSA）。在细胞输注当天，41.5%的患者仍在使用 BSA。8%的患者出现中性粒细胞植入失败。移植前菌血症和革兰氏阴性菌血症的累积发生率分别为 14.3%和 7.1%。再生障碍性贫血是移植前菌血症的独立危险因素[风险比（HR）=3.86，95%置信区间（CI）（1.29-11.5），P=0.02]。移植前肺炎的累积发生率为 11.2%。患者年龄显著增加了移植前肺炎的风险[HR=12.35，95%CI（1.27-120.50），P=0.03]。我们的队列中 6 个月的移植后死亡率达到 17%。骨髓增生异常综合征是唯一显著增加死亡风险的参数[HR=3.40，95%CI（1.05-10.98），P=0.04]。
在本队列中，移植前菌血症和肺炎的累积发生率分别为 14.3%和 11.2%。再生障碍性贫血预测菌血症的发生，患者年龄增加导致肺炎的发生，骨髓增生异常综合征增加死亡风险。
