Incidence, etiology, risk factors, and outcomes of pre‐engraftment bloodstream infections after first and second allogeneic hematopoietic cell transplantation

Abstract

Introduction:With an increasing number of allogeneic hematopoietic cell transplantations (allo-HCT) bloodstream infections (BSI) are still among the most common and serious complications. This study aimed to analyze the incidence, etiology, risk factors, and outcomes of pre-engraftment BSI after the first and the second allo-HCT.

Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

“…Previous studies have also reported that Enterococcus spp. were the major causative pathogens after the second HSCT and that previous HSCT was a risk factor for BSI with Enterococcus spp., which is consistent with the results of the present study ( 1 , 2 , 25 ). The risk of enterococcal infection increases as the duration of neutropenia increases, and in the present study, the high number of CBTs (characterized by a prolonged period of neutropenia) may have contributed to this increase ( 6 , 25 ).…”

“…The cumulative incidence of BSI at 30 days after the second HSCT was 36.5%, and this was an obvious increase compared with the cumulative incidence of BSI after the first HSCT. A study of 37 second-HSCT recipients [including 25 (67.6%) patients who underwent the second HSCT for graft failure] also reported a higher cumulative incidence of pre-engraftment BSI (35.1%) after the second HSCT than after the first HSCT ( 2 ). In another study that included 60 second-HSCT recipients [including 16 (27%) patients who underwent the second HSCT for graft failure], most bacterial infections, including BSI, occurred during the pre-engraftment period ( 1 ).…”

“…Continued improvements in hematopoietic stem cell transplantation (HSCT) technology have increased the feasibility and utilization of second HSCT procedures, which puts post-transplant recipients at an increased risk of worsening immunodeficiency. Infections after a second transplantation procedure can be common and are associated with high mortality ( 1 , 2 ). Nevertheless, studies on bloodstream infection (BSI) after second HSCT procedures are lacking.…”

Colonization by multidrug‐resistant bacteria in hematological patients undergoing hematopoietic stem cell transplantation and clinical outcomes: A single‐center retrospective cohort study

“…This corroborates with studies in the literature that report a smaller overall survival in carbapenem‐resistant K. pneumoniae ‐colonized patients when compared to noncolonized patients, with an approximate 35% survival rate in infected patients 37,38 . Other studies support that pre‐engraftment bloodstream infections caused by carbapenem‐resistant Gram‐negative bacteria are associated with extremely high nonrelapse mortality rates 39 . A positive rectal swab anticipated the onset of bacteremia in 12 of 13 cases of carbapenemase‐producing K. pneumoniae infections (92.3%), and all patients had at least one positive rectal swab.…”

“…37,38 Other studies support that preengraftment bloodstream infections caused by carbapenem-resistant Gram-negative bacteria are associated with extremely high nonrelapse mortality rates. 39 A positive rectal swab anticipated the onset of bacteremia in 12 of 13 cases of carbapenemase-producing K. pneumoniae infections (92.3%), and all patients had at least one positive rectal swab. This is a higher proportion than what was described in the literature 7 and justifies the need for active surveillance cultures.…”