Abdeljelil Nour Ben, Ouerghi Rihab, Yaiche Insaf Ben, Moussa Amine Ben, Chebbi Yosra, Othman Tarek Ben
Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia.
Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia.
Hematol Transfus Cell Ther. 2024 Dec;46 Suppl 6(Suppl 6):S208-S216. doi: 10.1016/j.htct.2024.05.009. Epub 2024 Aug 21.
Bacteremia is a serious complication in patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of this study was to determine the frequency, epidemiological profile, and risk factors of bacteremia early after allogeneic hematopoietic stem cell transplantation.
An observational descriptive retrospective study was conducted in patients who received transplants between January 2016 and December 2021. Early bacteremia was defined as blood stream infection occurring between Day 0 and Day 100 after transplantation.
Forty episodes of early bacteremia occurred in 36/245 transplanted patients. Fifteen episodes (37.5%) were due to gram-positive bacteria and 25 (62.5%) to gram-negative bacteria. The most frequent species isolated were coagulase negative staphylococci (CoNS) in gram-positive bacteremia (n = 8/15), and Klebsiella species (8/25) and Pseudomonas species (8/25) in gram-negative bacteremia. Twenty-nine episodes of bacteremia (72.5%) occurred during the first 30 days after transplantation with a median time of nine days (range: 0-90 days). Coagulase negative staphylococci were methicillin-resistant in 75% of cases, the only Staphylococcus aureus isolated was methicillin-resistant. All gram-positive bacilli were penicillin-resistant. Gram-negative bacilli were multidrug resistant in 61.5% of cases. In multivariate analysis, bone marrow as source of graft (p-value = 0.02) and cytomegalovirus reactivation (p-value = 0.02) were significantly associated with an increased risk of bacteremia. Mortality attributable to bacteremia was 2.8%. The one-year overall survival was not significantly different between those with and without bacteremia.
Bacteremia was more frequent within the first 30 days after transplantation indicating the crucial role of neutropenia. An increase in multidrug resistant gram-negative bacteremia was noted.
菌血症是异基因造血干细胞移植患者的一种严重并发症。本研究的目的是确定异基因造血干细胞移植后早期菌血症的发生率、流行病学特征及危险因素。
对2016年1月至2021年12月期间接受移植的患者进行了一项观察性描述性回顾性研究。早期菌血症定义为移植后第0天至第100天发生的血流感染。
245例移植患者中有36例发生了40次早期菌血症。15次（37.5%）由革兰氏阳性菌引起，25次（62.5%）由革兰氏阴性菌引起。革兰氏阳性菌血症中最常分离出的菌种是凝固酶阴性葡萄球菌（CoNS）（n = 8/15），革兰氏阴性菌血症中是克雷伯菌属（8/25）和假单胞菌属（8/25）。29次菌血症（72.5%）发生在移植后的前30天内，中位时间为9天（范围：0 - 90天）。凝固酶阴性葡萄球菌75%对甲氧西林耐药，分离出的唯一一株金黄色葡萄球菌对甲氧西林耐药。所有革兰氏阳性杆菌对青霉素耐药。革兰氏阴性杆菌61.5%对多种药物耐药。多因素分析显示，骨髓作为移植物来源（p值 = 0.02）和巨细胞病毒再激活（p值 = 0.02）与菌血症风险增加显著相关。菌血症导致的死亡率为2.8%。有菌血症和无菌血症患者的一年总生存率无显著差异。
移植后前30天内菌血症更为常见，表明中性粒细胞减少起关键作用。注意到耐多药革兰氏阴性菌血症有所增加。
