Polymicrobial bacterial or fungal infections: incidence, spectrum of infection, risk factors, and clinical outcomes from a large hematopoietic stem cell transplant center

Trifilio, Steve; Zhou, Zhuan; Fong, Jessica l; Zomas, Athanasios; Liu, D.; Zhao, Cindy; Zhang, J.; Mehta, Jayesh

doi:10.1111/tid.12363

Cited by 22 publications

(20 citation statements)

References 25 publications

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“…Remarkably, enterococci were the most frequent Gram-positive pathogens in patients with PBSI. Compared to previous studies, in which streptococcal BSI was the predominant Gram-positive infection [ 13 , 15 ], our data show that enterococci may be taking over from other Gram-positives. An interesting finding that has not previously been documented was the incidence of multidrug resistance, which reached 20% in our study.…”

Section: Discussioncontrasting

confidence: 83%

“…The existing literature regarding such polymicrobial BSI (PBSI) is very limited, and mainly comprises old retrospective studies in the general population [ 8 – 12 ]. Few reports have specifically focused on patients with cancer [ 13 – 15 ]. Moreover, the lack of consistent PBSI definitions and the heterogeneity of populations in the previous studies makes it very difficult to understand the true relevance of PBSI [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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A fresh look at polymicrobial bloodstream infection in cancer patients

et al. 2017

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ObjectivesTo assess the current incidence, clinical features, risk factors, aetiology, antimicrobial resistance and outcomes of polymicrobial bloodstream infection (PBSI) in patients with cancer.MethodsAll prospectively collected episodes of PBSI in hospitalised patients were compared with episodes of monomicrobial bloodstream infection (MBSI) between 2006 and 2015.ResultsWe identified 194 (10.2%) episodes of PBSI and 1702 MBSI (89.8%). The presence of cholangitis, biliary stenting, neutropenia, corticosteroids, neutropenic enterocolitis and other abdominal infections were identified as risk factors for PBSI. Overall, Gram-negative organisms were the most frequent aetiology, but Enterococcus spp. were especially frequent causes of Gram-positive PBSI (30.8%). Multidrug-resistant (MDR) organisms were more commonly found in PBSI than in MBSI (20.6% vs 12.9%; p = 0.003). Compared to patients with MBSI, those with PBSI presented with higher early (15% vs 1.4%; p = 0.04) and overall (32% vs 20.9%; p<0.001) case-fatality rates. Risk factors for overall case-fatality were a high-risk MASCC (Multinational Association of Supportive Care in Cancer) index score, corticosteroid use, persistent bacteraemia and septic shock.ConclusionsPBSI is a frequent complication in patients with cancer and is responsible for high mortality rates. Physicians should identify patients at risk for PBSI and provide empiric antibiotic therapy that covers the most frequent pathogens involved in these infections, including MDR strains.

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Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

A fresh look at polymicrobial bloodstream infection in cancer patients

et al. 2017

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“…We also detected only one case of vancomycin‐resistant enterococcus (VRE). Overall polymicrobial infections were rare in our study as previously published . Although variable year to year, the overall low rate of CLABSI in our study signifies past and ongoing quality measures taken at our institution to decrease the incidence of line‐related infections.…”

Section: Discussionsupporting

confidence: 64%

Early infectious complications after autologous hematopoietic cell transplantation for multiple myeloma

Rahman

Rybicki

Hamilton

et al. 2019

Transplant Infectious Dis

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Background:The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care. Methods:We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007-2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS). Results:Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38-48), any infection 21% (17-25), bacterial 17% (14-21), viral 4% (3-7) and fungal 1% (0.5-3), central line-associated blood stream infection 3% (2-6), and Clostridium difficile colitis 6% (4-8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, P < 0.01), more readmissions (31% vs 8%, P < 0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, P < 0.01). A 100-day mortality was low and similar between groups (2% vs 1%, P = 0.28). In landmark analysis of 404 100-day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03-2.30], P = 0.03), although there was no difference in NRM and RFS. Conclusions: Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients. K E Y W O R D S autologous hematopoietic cell transplantation, bacterial infections, central line associated blood stream infection, Clostridium difficile, infections, multiple myeloma

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“…Notably, PBSI may present different clinical presentations, microbiological characteristics and outcomes compared with monomicrobial BSI. Gram-negative organisms were the most frequent causative agents in PBSI (6)(7)(8)(9) which is contrary to BSI (10). The mortality rate of patients with polymicrobial BSIs ranged from 14-43%, approximately two times the mortality rate of those with monomicrobial BSIs (11).…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

Pang

Chen

et al. 2020

Preprint

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Background and Objective Polymicrobial bloodstream infections (PBSI) in hospitalized patients are associated with increased mortality, while few studies have characterized the clinical features in this population. This study aimed to assess the risk factors and short-term prognosis of PBSI in hospitalized patients.Materials and Methods 4066 patients with culture-positive blood were included between January 1, 2015 and December 31, 2017 in the First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) in our study. 218 patients were diagnosed as PBSI. The patients were divided into two groups according to the outcome after 30-day follow-up. The number of survival group were 129, while the number of non-survival group were 89. The clinical data, identified microorganisms and severity models were compared between the two groups. A cox regression model was used to identify the risk factors of 30-day mortality in PBSI patients. Five prediction models were compared by Z-test to test the value of these models to predict outcome of PBSI.Results The patients in the non-survival group were more likely to receive inappropriate antibiotic therapy at the time of PBSI and showed more severe in systemic inflammatory. They were more likely to develop to be septic shock and to be admitted in ICU than the patients in the survival group. Inappropriate initial empirical antimicrobial therapy (HR=1.713 95% CI: 1.063-2.760, p=0.027), white blood cell (HR=1.740 95% CI: 1.002-3.020, p=0.049) and platelet (HR=2.940 95% CI: 1.754-4.930, p<0.001) were independent risk factors for 30-day mortality in PBSI patients. SOFA (AUROC=0.882, 95% CI=0.832-0.922) scores was a good prognostic scoring system for predicting short-term mortality in PBSI patients. The SOFA score was more valuable than the other four models in predicting the outcome of PBSI according to the Z-test (p<0.05).Discussion and Conclusions Inappropriate initial empirical antimicrobial therapy, white blood cell and platelet were closely associated with short-term mortality.

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Polymicrobial bacterial or fungal infections: incidence, spectrum of infection, risk factors, and clinical outcomes from a large hematopoietic stem cell transplant center

Abstract: The results show co-infection with multiple organisms during HSCT is relatively rare; however, these patients are at an increased risk for the development of acute graft-versus-host disease, delayed engraftment, and overall mortality.

Cited by 22 publications

References 25 publications

A fresh look at polymicrobial bloodstream infection in cancer patients

A fresh look at polymicrobial bloodstream infection in cancer patients

Early infectious complications after autologous hematopoietic cell transplantation for multiple myeloma

Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

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