Gram-negative bacteraemia (GNB) after 428 unrelated donor bone marrow transplants (UD-BMT): risk factors, prophylaxis, therapy and outcome

Abstract

Summary:Gram-negative infection is an important cause of morbidity and mortality after unrelated donor-bone marrow transplantation (UD-BMT). We performed a retrospective case-control study to examine the risk factors, prophylaxis, therapy and outcome of Gram-negative bacteraemia (GNB) in 428 patients undergoing UD-BMT. The incidence of GNB was 3.6% in children and 19% in adults. Of the adults, 11% developed GNB 460 days post UD-BMT. Predisposing risk factors for GNB included 'high-risk' disease status, chronic graft-versushost disease and use of systemic steroids. Fever, a raised C-reactive protein (CRP) and hypotension were common findings at presentation. Patients were routinely given prophylactic ciprofloxacin: resistance to this antibiotic was seen in 33% of isolates. We identified an age-matched control group undergoing UD-BMT over the same time period as the study group. Gram-positive bacteraemia was significantly more common in cases than controls. Mortality from GNB was 17% in children and 24% in adults. We conclude that GNB is a common complication of UD-BMT with a high associated mortality. Patients should be educated further to present rapidly with symptoms suggestive of infection.

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

“…General trends in contemporary studies include an overall decreased incidence of BSI compared to earlier studies. 22,36,37 While the overall incidence of BSI by gram negative bacteria has decreased, the proportion of BSI caused by fluoroquinolone-resistant bacteria has increased compared with prior studies (Table 1). Similarly, contemporary microbial epidemiology data in pediatric HCT over the last 5 years demonstrates a decrease in CLABSI rates with a suggestive trend toward less predominance of gram positive bacteria and selection of multidrug resistant (MDR) pathogens (Table 2).…”

“…Risk factors for BSI include age greater than 18 years, use of unrelated graft source and myeloablative conditioning regimen, acute GvHD, mucositis, transplant-associated thrombotic microangiopathy (TA-TMA), high-risk malignant disease and steroid use 5,22 (Figure 2). …”

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

“…These include age greater than 18 years, underlying disease, late stage of underlying disease, the presence of a Hickman catheter infection, severe graft-versus-host disease (GVHD), mucositis and steroid use. 4,10,[15][16][17][18][19] However, not all studies are in agreement.…”

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

“…Both acute and chronic GVHD are known risk factors for BSI in allogeneic transplant recipients. 6,9,23 GVHD may cause profound immunodeficiency with B-and T-cell depletion, impairment of lymphocyte function and neutropenia. 24 Patients with GHVD have also been found to have suboptimal serum opsonizing activity due to the associated hypogammaglobulinemia.…”

“…Nevertheless, the differences between infections occurring pre-and post-engraftment have not been fully described. 2,6 Most published articles regarding BSI in HSCT recipients are retrospective and/or focus on subjects who underwent transplantation in the 1990 s. 3,[5][6][7][8][9][10] Since then, there have been changes in the care of HSCT recipients, such as the introduction of different types of donors, different immunosuppression, conditioning chemotherapy including reduced-intensity regimens, and so on. Furthermore, changes in the etiology of BSI in cancer patients have recently been described.…”