Risk Factors for Anaerobic Bloodstream Infections in Bone Marrow Transplant Recipients

Lark, Rebecca L.; McNeil, Shelly; VanderHyde, K; Noorani, Zehra; Uberti, Joseph P.; Chenoweth, Carol E.

doi:10.1086/322595

Cited by 101 publications

(63 citation statements)

References 14 publications

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“…Anaerobic BSIs have increasingly been recognized as an important sequela of high-dose chemotherapy, with severe alimentary tract mucositis identified as a predisposing risk-factor (11). While members of the genus Leptotrichia have been isolated from neutropenic patients (1,6,(12)(13)(14)19), they likely remain an underappreciated cause of BSI due to inherent difficulties with conventional laboratory identification methods (12).…”

Section: Discussionmentioning

confidence: 99%

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Leptotrichia Bacteremia in Patients Receiving High-Dose Chemotherapy

et al. 2012

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Leptotrichia spp. are anaerobic, pencil-shaped, Gram-negative rods that are part of the normal oral and intestinal human flora. Although not typically considered pathogenic, invasive Leptotrichia infections have been reported in immunosuppressed patients. A perceived rise in the identification of Leptotrichia spp. at our institution prompted a retrospective evaluation of these infections. Laboratory and clinical records were reviewed to identify Leptotrichia culture-positive patients. Over a 5-year period, 68 Leptotrichia-positive specimens were identified. Of these, 21% (14/68) were identified in original samples submitted from 13 different patients at our institution, and the remainder (79% [54/68]) were unknown isolates referred from outside hospitals for molecular identification. All in-house Leptotrichia were identified from blood cultures. Only 64% (9/14) of these grew on solid media, and 5 were a part of polymicrobial bacteremias containing other enteric pathogens. All local patients were receiving chemotherapy and a majority received hematopoietic stem cell transplant (HSCT) (11/13). All had neutropenic fever with symptoms of mucositis and/or enteritis. Most of the HSCT patients (73% [8/11]) were autologous recipients hospitalized after recent highdose chemotherapy for multiple myeloma. L. hongkongensis, a novel species, was found in the majority of myeloma cases (63% [5/8]). In conclusion, we suggest that Leptotrichia spp. may be an underappreciated cause of bacteremia, particularly in multiple myeloma patients receiving cytotoxic chemotherapy for autologous HSCT. In our cohort, these infections were associated with neutropenic fever from an enteric source, and most isolates remained sensitive to standard antibiotics. H igh-dose chemotherapy followed by hematopoietic stem-cell transplantation (HSCT), is a well-established treatment modality for a variety of hematologic malignancies; however, infectious complications remain a major barrier to the overall success of this procedure. HSCT recipients are at particularly high risk for the development of invasive bacterial infections as a result of regimen-related neutropenia and cytotoxic damage to the oral and gastrointestinal mucosa. Mucositis severity, specifically, is an independent predictor of anaerobic bloodstream infection (BSI) following HSCT (11).Leptotrichia spp. are fastidious anaerobic, pencil-shaped, Gram-negative rods that reside in the mouths, intestines, and female genital tracts of humans (20). Traditionally considered to be nonpathogenic, Leptotrichia species have occasionally been reported to cause invasive disease in HSCT patients and other immunocompromised hosts (6, 14, 18). The overall incidence of Leptotrichia infections in at-risk patient populations, however, may be underestimated. These organisms are notoriously difficult to recover from blood culture and may retain crystal violet, which can lead to their misidentification as Gram-positive rods. Commercially available phenotypic identification systems also have problems classifying...

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Section: Discussionmentioning

confidence: 99%

“…HSCT recipients are at particularly high risk for the development of invasive bacterial infections as a result of regimen-related neutropenia and cytotoxic damage to the oral and gastrointestinal mucosa. Mucositis severity, specifically, is an independent predictor of anaerobic bloodstream infection (BSI) following HSCT (11).…”

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confidence: 99%

Leptotrichia Bacteremia in Patients Receiving High-Dose Chemotherapy

et al. 2012

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“…Severe OM interferes with daily activities such as speaking, eating and swallowing and has a negative impact on quality of life. 3,4 It can lead to dehydration, malnutrition and serious infections [5][6][7][8] and has been linked to inferior overall survival (P ¼ 0.002) after SCT. 6 Several US-based analyses from various cancer settings have demonstrated that severe OM increases healthcare resource utilization by necessitating opioid analgesia, antiinfective treatment, total parenteral nutrition (TPN) and subsequently prolonging hospitalization.…”

Section: Introductionmentioning

confidence: 99%

The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

McCann

Schwenkglenks

Bacon

et al. 2008

Bone Marrow Transplant

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The Prospective Oral Mucositis Audit was an observational study in 197 patients with multiple myeloma (MM) or non-Hodgkin's lymphoma (NHL) undergoing, respectively, high-dose melphalan or BEAM chemotherapy and autologous SCT at 25 European centres. We evaluated the relationship between severe oral mucositis (SOM; WHO Oral Toxicity Scale grade 3-4) and local and systemic clinical sequelae and medical resource use. SOM occurred in 44% of patients. The duration of SOM (mean 5.3 days) correlated with time to neutrophil engraftment. The following parameters increased gradiently with maximum grade of oral mucositis: duration of pain score X4, opioid use, dysphagia score X4, total parenteral nutrition (TPN) use, incidence and/or duration of fever and infection, and duration of antibiotic use. SOM increased the duration of TPN use by 2.7 days (Po0.001), opioids by 4.6 days (Po0.001), and antibiotics by 2.4 days (P ¼ 0.045). SOM prolonged hospital stay by 2.3 days (P ¼ 0.013) in MM patients, but not in NHL patients (who tended to have a longer hospital stay).In conclusion, this analysis of prospectively collected observational data provides important insight into the scope and impact of SOM in the European transplant setting.

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“…29 We speculate that the dominant biologic processes operative during days 1-10 post transplant are gut mucosal damage, translocation of bacteria and endotoxin, and stimulation of innate immunity. 10,30 The gut mucosa is a site of acute phase protein and pro-inflammatory cytokine production in response to inflammation, sepsis, severe injury and other critical and chronic illnesses. [31][32][33] However, in the weeks before engraftment, we cannot be sure that donor alloimmune cells are not amplifying the inflammatory response despite their relatively small numbers.…”

Section: Discussionmentioning

confidence: 99%

Prolonged anorexia and elevated plasma cytokine levels following myeloablative allogeneic hematopoietic cell transplant

Malone

Leisenring

Storer

et al. 2007

Bone Marrow Transplant

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Myeloablative conditioning regimens commonly lead to prolonged anorexia and poor oral intake. In a prospective study of 147 patients receiving CY, total body irradiation and allogeneic hematopoietic cells, we determined the extent of decline in oral intake and assessed plasma cytokine levels and development of acute GVHD as explanations for protracted anorexia. For each patient, daily oral caloric intake was expressed as a percent of estimated basal requirements, calculated as basal energy expenditure, through day 20. Oral caloric intake was significantly reduced in 92% of patients and remained low. The nadir in oral intake occurred at days 10-12, when median oral caloric intake was 3% of basal energy requirements. Plasma cytokines known to affect appetite (IL2, IL6, tumor necrosis factor-alpha) were significantly elevated above normal following conditioning therapy (Po0.001 for each cytokine). Acute GVHD did not appear to affect oral intake to transplant day 20 in this cohort of patients; however, plasma levels of IL6 rose steeply before the clinical onset of GVHD. Persistent fever occurred with the greatest frequency in patients with most profound reduction in oral intake. We conclude that prolonged alterations in oral intake following this myeloablative regimen may be related to circulating cytokines known to alter eating behavior.

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Risk Factors for Anaerobic Bloodstream Infections in Bone Marrow Transplant Recipients

Cited by 101 publications

References 14 publications

Leptotrichia Bacteremia in Patients Receiving High-Dose Chemotherapy

Leptotrichia Bacteremia in Patients Receiving High-Dose Chemotherapy

The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT

Prolonged anorexia and elevated plasma cytokine levels following myeloablative allogeneic hematopoietic cell transplant

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