Basquiera Ana L, Aguirre María A, Serra Florencia A, Vaca Mayra, Brulc Erika B, Perusini María A, Ferini Gonzalo A, Schutz Natalia P, Otero Victoria, García Corbanini Damián, Litvack Edgardo, Giron Julio, Garnica Gastón, Martinez Bernardo, Michelangelo Hernán, San Román Eduardo, Pollán Javier, Fantl Dorotea B, Arbelbide Jorge A, Valledor Alejandra, Staneloni María I
Hematology Section, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Buenos Aires, Argentina.
Present Address: Hospital Privado Universitario de Córdoba, Naciones Unidas 346, 5016 Córdoba, Argentina.
Indian J Hematol Blood Transfus. 2023 Jan;39(1):7-14. doi: 10.1007/s12288-021-01497-8. Epub 2021 Oct 18.
A program for the hematologic patient at very high risk of infections (HAR, from its initials in Spanish) was implemented, based on a multidisciplinary team and six measures intended to reduce the colonization and subsequent sepsis by multidrug-resistant organisms (MDRO). We aimed at evaluating the effectiveness of the HAR program in terms of MDRO infections mainly caused by carbapenemase-producing and multidrug-resistant , and sepsis-related mortality. We established retrospective comparisons between the pre-HAR period (2016-2018) and the post-HAR period (2018-2019), in patients who received a hematopoietic stem cell transplant (HSCT) and/or intensive chemotherapy to treat non-M3 acute myeloid leukemia (CH-AML). We included 262 patients: 176 pre-HAR and 86 post-HAR. MDRO infection was 4.6% at 30 days and 6.1% at 90 days (all the cases during the pre-HAR period). Sepsis-related mortality was 6.5%, considering a median follow-up of 608 days: 6.1% in the HSCT group and 12.4% in the CH-AML group ( = 0.306). Sepsis-related mortality was 8.7% in the pre-HAR period and 0% in the post-HAR period ( = 0.014). The implementation of this multidisciplinary program based in preventive measures and the appropriate use of antibiotics enabled a decrease in sepsis-related mortality in very high-risk hematologic patients.
针对感染风险极高的血液科患者实施了一项计划（西班牙语首字母缩写为HAR），该计划基于多学科团队，并采取了六项措施，旨在减少多重耐药菌（MDRO）的定植及随后发生的败血症。我们旨在评估HAR计划在主要由产碳青霉烯酶和多重耐药菌引起的MDRO感染以及败血症相关死亡率方面的有效性。我们对接受造血干细胞移植（HSCT）和/或强化化疗以治疗非M3急性髓系白血病（CH-AML）的患者，在HAR计划实施前（2016 - 2018年）和实施后（2018 - 2019年）进行了回顾性比较。我们纳入了262例患者：HAR计划实施前176例，实施后86例。MDRO感染在30天时为4.6%，90天时为6.1%（所有病例均发生在HAR计划实施前）。考虑到中位随访时间为608天，败血症相关死亡率为6.5%：HSCT组为6.1%，CH-AML组为12.4%（P = 0.306）。败血症相关死亡率在HAR计划实施前为8.7%，实施后为0%（P = 0.014）。基于预防措施和合理使用抗生素的这一多学科计划的实施，使得感染风险极高的血液科患者的败血症相关死亡率有所降低。
