Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients

Abstract

We conducted an observational study to assess the etiology, clinical features and outcomes of bloodstream infection (BSI) in 172 hematopoietic SCT (HCST) recipients. One hundred episodes of BSI in the pre-engraftment period (early onset) were compared with 89 episodes in the post-engraftment phase (late onset). More patients with late-onset BSI received an allogeneic HSCT, had GVHD and had received corticosteroids, whereas patients with early-onset BSI were more likely to have neutropenia, severe mucositis and a central venous catheter (CVC) in place. CVC was the most frequent site of infection, followed by an endogenous source. Pneumonia and gastrointestinal infection were particularly frequent in late-onset BSI, whereas mucositis was more frequent in the early-onset group. Gram-positive organisms predominated over Gram negatives. Streptococcus pneumoniae was more frequent in patients with late-onset BSI. Patients with late-onset BSI presented worse outcomes regarding septic shock, intensive care unit admission and early and overall case-fatality rates. Early-onset BSI was mainly related to the presence of neutropenia, mucositis and CVC, whereas late-onset BSI mainly affected severely immunosuppressed allogeneic HSCT recipients with GVHD and corticosteroids. Late-onset BSI caused high case-fatality rates. BSI due to S. pneumoniae was especially frequent late after transplantation. The development of better vaccination strategies is needed.

Gut Microbiota Predict Pulmonary Infiltrates after Allogeneic Hematopoietic Cell Transplantation

“…The strength of association between mortality and postengraftment PCs was also interesting. In a study of HCT recipients with bloodstream infections, postengraftment events were associated with worse outcomes, including death (62). "Late onset" noninfectious PCs, which may be subjected to diagnostic inaccuracy (63), have been associated with acute and chronic GVHD (35,64,65) and mortality (66).…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…During the pre-engraftment period, important risk factors for BSI are neutropenia, presence of a CVC and severe mucositis. 21 In multivariate analysis, pre-engraftment BSI has been associated with engraftment failure and high-risk disease status at the time of HCT. 20 Post-engraftment BSIs are more commonly found in patients who undergo allo-HCT and have a history of acute (aGvHD) or chronic GvHD (cGvHD).…”

“…Patients with post-engraftment BSI received more antibacterial prophylaxis, previous antibiotic therapy and immunosuppression (corticosteroids and cyclosporine) than patients without BSI. 20,21 In addition, patients with postengraftment BSIs traditionally have poorer outcomes, with higher early and all-cause fatality rates. 21 …”

“…20,21 In addition, patients with postengraftment BSIs traditionally have poorer outcomes, with higher early and all-cause fatality rates. 21 …”

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

“…Some studies noted an increase in the number of S pneumoniae isolates, especially those resistant to ceftazidime, among febrile neutropenic patients, prompting an inquiry into the rates of pneumococcal vaccination. 71,72 Gudiol and colleagues 72 reported an increase in the number of vancomycin susceptible E faecium isolates with high-level resistance to ampicillin and fluoroquinolones, related to the use of antibiotic prophylaxis in these patients. These authors expressed concerns that this was a harbinger of future VRE as vancomycin use increases in such patients.…”