Background Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. Results The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45–3.13; P <.001) and auto-HSCT (2.43; 1.22–4.84; P = .01). Conclusions Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB. Clinical Trials registration NCT02088840.

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The objectives of this study were to evaluate the efficacy of percutaneous cardiopulmonary support (CPS) for circulatory assistance during electrophysiological endocavitary procedures for ventricular tachycardia (VT) in high-risk patients. From January to June 1999, eight patients with VT not haemodynamically tolerated, underwent an electrophysiological mapping and ablation while supported with percutaneous CPS in the cardiac surgery service of the University of Milan. The CPS system allowed for the maintenance of an arterial pressure of 60-70 mmHg during the tachycardia episodes. CPS was used for 10-20 min periods to restore haemodynamic stability. With the haemodynamic support of CPS, it was possible to target and induce 21 VTs, with a mean cycle of 325 ms. The mean support time was 140 min (120-160 min). Stabilization of the arterial pressure at a mean value of 65 mmHg (55-85 mHg) was achieved over a mean period of 26 seconds. Oxygen saturation remained over 90% throughout the support for all patients, with no blood gas or electrolyte abnormalities. No CPB-related complications were observed. In conclusion, percutaneous CPS guarantees effective haemodynamic support during mapping and ablation of VTs not haemodynamically tolerated, with no complications related to the extracorporeal circulation or the cannulation.

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