Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon

Moghnieh, Rima; Tamim, Hani; Abyad, Amin; Jadayel, Marwa; Awad, Lyn; Abdallah, Dania; Haddad, Nicholas; Berberi, Jessica; Alwazir, Rawya; Taher, Rida; Jisr, Tamima; Lakkis, Rawad; Zahran, Kamal M.; Ibrahim, Ahmad

doi:10.1007/s15010-020-01407-6

Cited by 4 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Being an HCT recipient and having a chronic wound or ulcer, in addition to history of cerebrovascular disease, majorly including cerebrovascular accidents, were factors identified in other recent studies 27 . This may be explained by the recurring admissions and discharges as well as a relatively longer length of stay in this sick bedridden patient population prone to developing recurrent infections and exposing them to greater risk than the general patient population, not to mention the prolonged exposure to multiple courses of antibiotics 28 , 29 . It is worth noting that HCT is the only available type of transplantation being performed in our center where this fact might have created a sort of bias regarding which type of transplant could have been associated with CRE acquisition.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Moghnieh

Abdallah

Jadayel

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical significance (P < 0.05) were included in the forward stepwise multiple logistic regression analysis. To develop the CRE acquisition risk score, variables that maintained statistical significance in the multivariate model were assigned a point value corresponding to the odds ratio (OR) divided by the smallest OR identified in the regression model, and the resulting quotient was multiplied by two and rounded to the nearest whole number. Summation of the points generated by the calculated risk factors resulted in a quantitative score that was assigned to each patient in the database. Predictive performance was determined by assessing discrimination and calibration. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. The incidence of CRE acquisition significantly increased with time from 0.21 cases/1000 patient-days (PD) in 2015 to 1.89 cases/1000PD in 2019 (r2 = 0.789, P = 0.041). Multivariate analysis of matched data revealed that the history of cerebrovascular disease (OR 1.96; 95% CI 1.04–3.70; P = 0.039), hematopoietic cells transplantation (OR 7.75; 95% CI 1.52–39.36; P = 0.014), presence of a chronic wound (OR 3.38; 95% CI 1.73–6.50; P < 0.001), endoscopy done during the 3 months preceding the index hospitalization (OR 2.96; 95% CI 1.51–4.73; P = 0.01), nosocomial site of acquisition of the organism in question (OR 2.68; 95% CI 1.51–4.73; P = 0.001), and the prior use of meropenem within 3 months of CRE acquisition (OR 5.70; 95% CI 2.61–12.43; P < 0.001) were independent risk factors for CRE acquisition. A risk score ranging from 0 to 25 was developed based on these independent variables. At a cut-off of ≥ 5 points, the model exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 64.5%, 85.8%, 82%, 70.7% and 75%, respectively. We also showed that only meropenem consumption intensity and CRE acquisition incidence density showed a strong positive correlation(r = 0.798, P = 0.106), unlike imipenem (r = − 0.868, P = 0.056) and ertapenem (r = 0.385, P = 0.522). Patients with a score of ≥ 5 points in our model were likely to acquire CRE. Only meropenem was associated with CRE carriage. Our proposed risk prediction score would help target surveillance screening for CRE amongst inpatients at the time of hospital admission and properly guide clinicians on using anti-CRE therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Moghnieh

Abdallah

Jadayel

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…During the pre-engraftment neutropenic phase, the dysbiosis of endogenous gastrointestinal flora, mucosal damage with indwelling devices, and prior colonization with MDRO can contribute to different clinical manifestations, including bloodstream infections (BSIs), pneumonia and gastrointestinal infections. 12,13 Despite major advances in the management of post-transplant outcomes, the incidence ranges from 13-46% and 5-10% among allogeneic HSCT, in which patients receive progenitor cells from the donor 13,14 and autologous HSCT, in which the patient receives their own progenitor cells, 15 respectively, with a mortality rate of 32.7%. 16 Although active surveillance strategies to detect the colonization state of HSCT recipients are important tools for controlling and preventing the spread of MDRO within hospital settings and may be useful in guiding empirical therapy for post-transplantation neutropenia, their impact on patient outcome and cost-effectiveness remains controversial, 17 particularly in developing countries where MDRO is endemic.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation

Kamel,

Abdalla,

Al Ali

et al. 2024

IDR

View full text Add to dashboard Cite

Owing to the rising incidence of multidrug-resistant organisms (MDRO) and the high mortality rates associated with such bacterial infections post-hematopoietic stem cell transplantation (HSCT), we investigated the MDRO colonization rate prior to transplantation using an active surveillance approach and determined its impact on subsequent infection during the pre-engraftment period. Methods: A single-center observational study was conducted, and surveillance cultures from multiple body sites, including the rectum, nasal cavity, and groin, were performed at admission to determine MDRO colonization. Serological tests were used to detect certain viruses and toxoplasmosis before HSCT. Results: In the pre-transplant setting, 59 MDRO were recovered from the 40 HSCT recipients. Of the 59 isolates recovered from one or more body sites, 29 were positive for methicillin-resistant Staphylococcus aureus (MRSA), 7 for carbapenem-resistant Enterobacterales (CRE), and 23 were positive for extended-spectrum β-lactamase (ESBLs). Serological assessment before HSCT revealed active or reactivation of latent infection with cytomegalovirus (7.5%), Epstein-Barr virus (EBV; 5%), and Toxoplasma gondii (2.5%) among HSCT patients. In terms of factors associated with pre-engraftment infections, the type of transplant (p=0.04) was statistically significant, whereas other factors, such as age, sex, and underlying conditions, were not. In post-transplant settings, bloodstream infections (BSIs) were documented in 2 allogeneic HSCT patients (5%), and the isolated microorganisms were ESBLproducing E. coli and non-MDR Acinetobacter baumannii. Conclusion: Active screening cultures are a helpful tool for identifying patients colonized by MDRO or relevant viruses before HSCT, and for predicting those at risk of developing subsequent pre-engraftment infections. Additionally, active screening may aid in predicting those who are likely to develop subsequent pre-engraftment infections Our findings highlight the importance of pretransplant screening for high-priority multidrug-resistant pathogens and the application of infection control interventions after HSCT.

show abstract

“…Hematopoietic cell transplantation (HCT) has been a wellestablished therapy for numerous malignant and non-malignant diseases. [1][2][3] The primary disorders necessitating HCT, conditioning regimens used, source of transfused cells, and immunosuppressive therapy utilized differ across institutions and have evolved over time. [1][2][3] Despite considerable progress, HCT continues to be associated with major risks, mainly infectious complications during the peri-engraftment period.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] The primary disorders necessitating HCT, conditioning regimens used, source of transfused cells, and immunosuppressive therapy utilized differ across institutions and have evolved over time. [1][2][3] Despite considerable progress, HCT continues to be associated with major risks, mainly infectious complications during the peri-engraftment period. 3 The risk of infection depends on type of malignancy, duration of neutropenia, intensity of the immunity ablation, type of radiation therapy, remission status and timing of transplant and engraftment.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Despite considerable progress, HCT continues to be associated with major risks, mainly infectious complications during the peri-engraftment period. 3 The risk of infection depends on type of malignancy, duration of neutropenia, intensity of the immunity ablation, type of radiation therapy, remission status and timing of transplant and engraftment. 4 Many pathogens may cause life-threatening infections during these periods.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

QTc prolongation during levofloxacin and triazole combination chemoprophylaxis: Prevalence and predisposing risk factors in a cohort of hematopoietic cell transplantation recipients

Moghnieh

Khalil

Bizri

et al. 2022

J Oncol Pharm Pract

Self Cite

View full text Add to dashboard Cite

Background QTc interval prolongation has been reported when combining fluoroquinolones and triazoles for chemoprophylaxis in cancer patients. Herein, we aimed to identify the prevalence and contributing factors to QTc prolongation in hematopoietic cell transplantation (HCT) recipients who received these agents during the neutropenic phase. Methods This is a retrospective medical chart review conducted at a university hospital in Lebanon from 2017 to 2020. It included all adult HCT inpatients on antimicrobial prophylaxis with fluoroquinolones and triazoles and whose baseline ECG monitoring done prior to chemoprophylaxis administration, then on day-3 and day-6 of therapy, were available. Results Overall, 68 HCT recipients met our inclusion criteria, of which 22% developed QTc prolongation. Based on bivariate analysis, female gender contributed to QTc prolongation ( P = 0.001). There was a trend to QTc prolongation in patients with predisposing thyroid disease ( P = 0.12), grade 2 vomiting and diarrhea ( P = 0.16, P = 0.46, respectively), baseline hypokalemia ( P = 0.18) and hypocalcemia ( P = 0.3), hypomagnesemia on day-3 ( P = 0.21) and day-6 hyponatremia ( P = 0.36). Patients receiving two or more drugs with a known or probable risk of QTc prolongation (other than the fluoroquinolone/ triazole combination) were more prone to experience a prolonged QTc interval ( P = 0.09). None of the patients that had QTc prolongation died or developed serious arrhythmias. Conclusion The prevalence of QTc prolongation was 22% among HCT recipients on fluoroquinolone and triazole prophylaxis, yet we did not identify any independent risk factors for this issue. None of the patients that had QTc interval prolongation died or developed serious arrhythmias.

show abstract

Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon

Cited by 4 publications

References 39 publications

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation

QTc prolongation during levofloxacin and triazole combination chemoprophylaxis: Prevalence and predisposing risk factors in a cohort of hematopoietic cell transplantation recipients

Contact Info

Product

Resources

About