Eryilmaz-Eren Esma, Izci Feyza, Ture Zeynep, Sagiroglu Pinar, Kaynar Leylagul, Ulu-Kilic Aysegul
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Kayseri City Education and Research Hospital, Kayseri, Türkiye.
Department of Infectious Diseases and Clinical Microbiology, Erciyes University, Faculty of Medicine, Kayseri, Türkiye.
Infect Chemother. 2022 Sep;54(3):446-455. doi: 10.3947/ic.2022.0005. Epub 2022 Jul 29.
Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis.
This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia.
There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were and spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively.
High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.
菌血症是造血干细胞移植（HSCT）受者常见的并发症。推荐并在这些个体中使用预防性氟喹诺酮类药物。耐氟喹诺酮菌株可导致突破性感染。我们旨在确定接受氟喹诺酮预防的HSCT受者菌血症的发生率、耐药性及危险因素。
本回顾性研究对2015年至2019年间接受氟喹诺酮预防并进行自体和异体HSCT的患者进行。比较了这些有菌血症和无菌血症患者的菌血症发生率、合并症、治疗及侵入性操作情况。
该研究共纳入553例患者，68例（12.3%）发生菌血症。自体HSCT受者菌血症发生率为8.2%，异体HSCT受者为18.4%。与菌血症相关的显著危险因素在自体HSCT中为使用类固醇（比值比[OR]：13.83，95%置信区间[CI]：2.88 - 66.40）、较高的查尔森合并症指数（CCI）均值（OR：1.57，95% CI：1.15 - 2.16）、糖尿病（OR：4.29，95% CI：1.11 - 16.48）；在异体HSCT中为使用类固醇（OR：6.84，95% CI：1.44 - 32.33）、中性粒细胞减少持续时间较长（OR：1.05，95% CI：1.01 - 1.09）、使用中心静脉导管（OR：7.81，95% CI：1.00 - 61.23）。从68例菌血症发作中共分离出73种病原体。最常见的病原体是[此处原文缺失具体病原体名称]和[此处原文缺失具体病原体名称]菌属。这些菌株对氟喹诺酮的耐药率分别为87.2%、70.0%和60.0%。
高CCI、糖尿病、使用类固醇、长期中性粒细胞减少及使用中心静脉导管与接受氟喹诺酮预防的HSCT受者突破性菌血症显著相关。氟喹诺酮预防可能会降低菌血症的发生率，但可能会选择出耐氟喹诺酮的菌株。
