Infections in hematopoietic stem cell transplant patients admitted to Hematology intensive care unit: a single-center study

Abstract

Objective: The aim of this study was to investigate the data of HSCT patients who were admitted to our Hematology ICU due to infections or infectious complications. Materials and Methods: HSCT patients who were admitted to our Hematology ICU between 01 January 2014 and 01 September 2017 were analyzed retrospectively. Results: 62 HSCT patients were included in this study. The median age was 55.5 years and 58% of the patients were allogeneic HSCT patients. Major underlying hematologic disorders were multiple myeloma (29%) and lymphoma (27.4%). The most common reasons for ICU admission were sepsis/septic shock (61.3%) and acute respiratory failure (54.8%). Overall ICU mortality rate was 45.2%. However, a lot of factors were related with ICU mortality of HSCT patients in univariate analysis, only APACHE II score was found to be an independent risk factor for ICU mortality. While there was infection in 58 patients at ICU admission, new infections developed in 38 patients during ICU stay. The most common new infection was pneumonia/VAP, while the most frequently isolated bacteria were Acinetobacter baumannii. Length of ICU stay, sepsis/septic shock as a reason for ICU admission and the presence of urinary catheter at ICU admission were determined factors for ICU-acquired infections. There was no difference between autologous and allogeneic stem cell transplant patients in terms of ICU morbidities and mortality. However, pneumonia/VAP developed in the ICU was higher in autologous HSCT patients, while bloodstream/catheter-related bloodstream infection was higher in allogeneic HSCT patients. Conclusion: It was concluded that early or late post-HSCT infections and related complications (sepsis, organ failure, etc.) constituted a major part of the reasons for ICU admission, ICU mortality and ICU morbidities.

Clinical Characteristics of Bloodstream Infection in Immunosuppressed Patients: A 5-Year Retrospective Cohort Study

“…IS patients easily suffered from multiple infections resulting in admission to ICU. Infectious complications contributed to the highly mortality in IS status ( Barlas et al., 2021 ). In our study, the conclusion was the same as in previous studies: age, PCT, and diabetes could be independent factors for ICU admission ( Fraunberger et al., 2006 ; Martin et al., 2006 ; Blanchard et al., 2020 ).…”

“…Patients meeting any of the following criteria for immunosuppression were selected: (1) tumor (organ and blood system); (2) solid-organ, stem cell, or bone marrow transplantation states; (3) autoimmune diseases with immunosuppressive therapy (more than 10 mg of prednisone or equivalent per day for at least 3 weeks or oral methotrexate, cyclosporine, azathioprine, or biological modifiers within 3 months); (4) poor diabetes control; (5) liver cirrhosis; (6) postoperative critical condition; and (7) burns ( McCann et al., 2004 ; Blanchard et al., 2020 ; Lindell et al., 2020 ; Mada et al., 2020 ; Barlas et al., 2021 ; Turkkan et al., 2021 ).…”

“…Thus, some indicators are needed to evaluate the clinical outcome. Previous investigations revealed that indicators like procalcitonin (PCT), age, intensive care unit (ICU) stay, malignancy, resistant bacterial infection, stroke, sex, diabetes mellitus, chronic renal failure, and previous use of antibiotics could indicate a poor prognosis of bloodstream infection ( Zhang et al., 2019 ; Blanchard et al., 2020 ; Barlas et al., 2021 ; Chen et al., 2021 ; Jain et al., 2021 ; Zduniak et al., 2021 ).…”

The Prognostic Factors of Bloodstream Infection in Immunosuppressed Elderly Patients: A Retrospective, Single-center, Five-year Cohort Study

“…The high mortality in immunosuppressive status was also caused by infectious complications. 16 Studies showed that diabetic patients, who had an experience of ICU admission, presented high mortality when developing bacterial infections, mostly depending on the age of the patients. 15 Previous investigations also showed that ICU admission was an indicator in hematopoietic stem cell transplant patients who developed a bloodstream infection.…”

“…Immunosuppressed patients included the patients under immunosuppressive therapy (use of drugs like corticosteroids [prednisone equivalent > 20 mg/day] for at least 14 days, or methotrexate, cyclosporine, azathioprine, or biological modifiers within three months), posttransplantation includes solid-organ, stem cell, or bone marrow transplantation, cancer includes solid organ and hematological system tumors, burns, diabetes, liver cirrhosis, and critical postoperative condition. 5,[7][8][9][14][15][16] Exclusion criteria: patients age <65 years and incomplete data were excluded from the study.…”