Infection prevention practices among EBMT hematopoietic cell transplant centers: the EBMT Infectious Disease Working Party survey

Yeshurun, Moshe; Rozovski, Uri; Shargian, Liat; Pasvolsky, Oren; Werf, Steffie van der; Tridello, Gloria; Knelange, Nina; Mikulska, Małgorzata; Styczyński, Jan; Averbuch, Dina; Cámara, Rafael de la

doi:10.1038/s41409-023-01916-6

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…In another systematic review of patients with cancer and stem cell transplantation recipients, FQ prophylaxis reduced bacteremia but did not significantly reduce overall mortality 28 . A very recent survey about infection prevention practices among EBMT hematopoietic transplant centers 29 reported a little higher percentage of 66 and 72%—compared to our survey—of routine prophylaxis in the neutropenic phase after autologous and allogeneic transplantation, respectively.…”

Section: Discussioncontrasting

confidence: 64%

Screening for multidrug‐resistant organisms in high‐risk hospitalized patients with hematologic diseases

Delanote,

Callens,

Vogelaers

et al. 2023

European J of Haematology

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ObjectivesPatients treated for hematologic malignancies are at higher risk for blood stream infections (BSI) and multidrug‐resistant organisms (MDRO) are increasingly involved. Studies showed a significant association between rectal colonization status and a higher risk of subsequent MDRO BSI. The objective of our study was to probe the practice of surveillance cultures in Belgian hematology centers.MethodsA questionnaire was sent to the 13 hematology centers participating in the acute leukemia board of the Belgian Hematology Society. 21 questions probed for the method of surveillance cultures, MDRO screened, antimicrobial prophylaxis, and empirical therapy and their relationship with colonization status.ResultsAll centers completed the questionnaire in full. Routine gastrointestinal surveillance cultures in hematologic patients are taken in 10 hospitals. Organisms tested for included mostly ESBL (n = 9) and carbapenem‐resistant (n = 8) Enterobacterales. All centers with a screening strategy adapt empiric antibiotic therapy based on MDRO colonization. Prophylaxis strategies are variable, only two centers adapt prophylaxis upon documentation of fluoroquinolone resistance.ConclusionsThe majority of the Belgian centers perform routine surveillance cultures and adapt empiric therapy for neutropenic fever accordingly. Other reasons for testing include to gain insight into local epidemiology and to prevent in‐hospital transmission. In general, there was significant variability in surveillance dimensions.

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Section: Discussioncontrasting

confidence: 64%

Screening for multidrug‐resistant organisms in high‐risk hospitalized patients with hematologic diseases

Delanote,

Callens,

Vogelaers

et al. 2023

European J of Haematology

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“…10,11 Infections are reported as the primary cause of death in 7%-15% of autologous patients and 17%-25% of allogeneic HCT recipients. 5,[7][8][9] The immunosuppressive nature of the conditioning regimen in both autologous and allogenic regimens cause a period of neutropenia in the recipient which is a window for opportunistic pathogens (Table 1). Autologous HCT recipients generally have a shorter period of neutropenia due to the widespread use of granulocyte stimulating factors and the infusion of their own stem cells, without the need for immunosuppressive agents.…”

Section: Autologous Versus Allogeneic Hctmentioning

confidence: 99%

“…An allogenic HCT recipient similarly receives a potent conditioning regimen, followed by the administration of donor stem cells to restore normal haematopoiesis and in some cases treat malignancy 10,11 . Infections are reported as the primary cause of death in 7%–15% of autologous patients and 17%–25% of allogeneic HCT recipients 5,7–9 . The immunosuppressive nature of the conditioning regimen in both autologous and allogenic regimens cause a period of neutropenia in the recipient which is a window for opportunistic pathogens (Table 1).…”

Section: Autologous Versus Allogeneic Hctmentioning

confidence: 99%

“…With advances in diagnostic measures, treatment options and evidence‐based recommendations for infection prophylaxis for HCT recipients, there has been a reduction in infection‐related mortality (IRM) 3 . Despite this, death due to infection is one of the leading nonrelapse mortality risks after HCT 5–9 . This can occur months after transplant due to a naïve immune function and continued immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

“…3 Despite this, death due to infection is one of the leading nonrelapse mortality risks after HCT. [5][6][7][8][9] This can occur months after transplant due to a naïve immune function and continued immunosuppression. A recent large registry study demonstrated that IRM was the leading cause of death after HCT in adults at day 100 at 6.2% and 9.8% at 1-year post-HCT.…”

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confidence: 99%

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Expanding the scope of the infectious diseases pharmacist in HCT: Beyond antimicrobial stewardship

Weerdenburg

Lindsay

2023

Transplant Infectious Dis

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BackgroundInfectious disease (ID) pharmacists and antimicrobial stewardship (AMS) programs are integral to the infection management of hematopoietic cell transplant (HCT) recipients demonstrating effective implementation of clinical pathways, de‐escalation of empirical antibiotics for febrile neutropenia (FN), allergy assessments, and use of rapid diagnostic testing. The HCT procedure is complex, dynamic, and a high risk for infectious complications. Therefore, there is an important role for an ID and AMS pharmacist to collaborate with the primary treating team, with ongoing care, involving the optimal individual patient prophylactic, pre‐emptive and treatment management of infections in this high‐risk population.ConclusionThis review highlights key factors for consideration of ID/AMS Pharmacists in relation to HCT, including important aspects in the evaluation of infection risk prior to transplant, risk from donor sources, length of, and changes in immunosuppression, and potential drug‐drug interactions from other essential supportive care therapies. image

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Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity

de Jonge,

Janssen,

Ypma

et al. 2024

Support Care Cancer

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Purpose Haematology patients with high-risk neutropenia are prone to mucosal-barrier injury-associated laboratory-confirmed bloodstream infections (MBI-LCBI). We assessed risk factors for MBI-LCBI including candidaemia in neutropenic haematology patients with fever. Methods This prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia < 500/mL for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of neutropenia > 500/mL or discharge. Results We included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia. Conclusion In haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI. Trial registration ClinicalTrials.gov (NCT02149329) at 19-NOV-2014.

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Infection prevention practices among EBMT hematopoietic cell transplant centers: the EBMT Infectious Disease Working Party survey

Cited by 5 publications

References 28 publications

Screening for multidrug‐resistant organisms in high‐risk hospitalized patients with hematologic diseases

Screening for multidrug‐resistant organisms in high‐risk hospitalized patients with hematologic diseases

Expanding the scope of the infectious diseases pharmacist in HCT: Beyond antimicrobial stewardship

Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity

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