异基因造血细胞移植后血流感染及结局：一项单中心研究。
Bloodstream Infections and Outcomes Following Allogeneic Hematopoietic Cell Transplantation: A Single-Center Study.
机构信息
Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network. Toronto, Ontario, Canada.
Section of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network. Toronto, Ontario, Canada; Bone Marrow Transplant Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Spain.
出版信息
Transplant Cell Ther. 2022 Jan;28(1):50.e1-50.e8. doi: 10.1016/j.jtct.2021.10.008. Epub 2021 Oct 14.
This study investigated the single-center incidence and risk factors for bloodstream infections (BSIs) in 651 adults who underwent allogeneic hematopoietic cell transplantation (alloHCT) between 2015 and 2019 and explored the impact of these BSIs on post-transplantation outcomes. Antibiotic prophylaxis with ciprofloxacin was given during the aplastic phase. Overall, the median patient age was 57 years, 79.7% of patients received an alternative donor graft, and 68.7% received post-transplantation cyclophosphamide (PTCy) as part of their graft-versus-host disease (GVHD) prophylaxis. Of the 651 patients, 358 (55.0%) had at least 1 episode of BSI, and the overall mortality rate secondary to this complication was 7.5% (12.6% among those diagnosed with at least 1 episode of BSI). BSI was more often diagnosed during the first 30 days (58.7%), and gram-positive bacteria were the most prevalent microorganisms isolated during the entire post-transplantation follow-up (62%). A high Disease Risk Index (hazard ratio [HR], 1.47; P < .029) and receipt of PTCy-based GVHD prophylaxis (HR, 3.33; P < .001) were identified as risk factors for BSI. Additionally, univariate analysis showed that patients diagnosed with a BSI during post-transplantation follow-up had worse overall survival (HR, 2.48; P < .001) and higher nonrelapse mortality (HR, 2.68; P < .001) than those without BSI. In conclusion, alloHCT recipients with a BSI had a higher risk of mortality compared with those who did not develop BSI. The inclusion of PTCy as part of GVHD prophylaxis was identified as an independent risk factor for BSI during early post-transplantation follow-up. Single-center analyses focused on reporting the incidence and risk factors for BSI highlight the need for active implementation of preemptive strategies to decrease BSI incidence in the alloHCT setting. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
这项研究调查了 2015 年至 2019 年间接受异基因造血细胞移植（alloHCT）的 651 例成年人中血流感染（BSI）的单中心发生率和危险因素，并探讨了这些 BSI 对移植后结局的影响。在再生不良期给予环丙沙星抗生素预防。总体而言，中位患者年龄为 57 岁，79.7%的患者接受了供者移植物，68.7%的患者接受了移植后环磷酰胺（PTCy）作为移植物抗宿主病（GVHD）预防的一部分。在 651 例患者中，358 例（55.0%）至少发生 1 次 BSI，该并发症导致的总死亡率为 7.5%（至少发生 1 次 BSI 的患者为 12.6%）。BSI 更常发生在移植后 30 天内（58.7%），整个移植后随访期间最常见的微生物分离株为革兰阳性菌（62%）。高疾病风险指数（hazard ratio [HR]，1.47；P <.029）和接受基于 PTCy 的 GVHD 预防（HR，3.33；P <.001）被确定为 BSI 的危险因素。此外，单因素分析显示，在移植后随访期间诊断为 BSI 的患者总生存率（HR，2.48；P <.001）和非复发死亡率（HR，2.68；P <.001）均较差，而未发生 BSI 的患者。总之，与未发生 BSI 的患者相比，发生 BSI 的 alloHCT 受者死亡率更高。将 PTCy 纳入 GVHD 预防的一部分被确定为移植后早期 BSI 的独立危险因素。以报告 BSI 发生率和危险因素为重点的单中心分析强调需要积极实施先发制人的策略，以降低 alloHCT 环境中的 BSI 发生率。
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