Risk Factors for Mortality in Hematopoietic Stem Cell Transplantation Recipients with Bloodstream Infection: Points To Be Addressed by Future Guidelines

Puerta‐Alcalde, Pedro; Chumbita, Mariana; Charry, Paola; Castaño-Díez, Sandra; Cardozo, Celia; Moreno-García, Estela; Marco, Francesc; Suárez‐Lledó, María; García‐Poutón, Nicole; Morata, Laura; Fernández‐Avilés, Francesc; Martínez‐Roca, Alexandra; Rodríguez, G. Fita; Martínez, José Antonio; Martı́nez, Carmen; Urbano, Álvaro; Rovira, Montserrat; Soriano, Álex; García-Vidal, Carolina

doi:10.1016/j.jtct.2021.03.017

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…However, to our knowledge, no studies have identified the risk factors for BSI after a second HSCT. CBT, which was found to be most closely associated with pre-engraftment BSI after the second HSCT in the present study, has also been reported as a risk factor in several previous studies on HSCTs ( 3 , 23 , 25 , 26 , 30 , 31 ). The higher incidence of BSI in cases of CBT may be due to several features of CBT, such as a prolonged neutrophil recovery period and delayed immune reconstitution ( 3 , 20 , 21 , 23 ).…”

Section: Discussionsupporting

confidence: 83%

“…Previous studies on HSCT have reported that the portion of BSI attributable to GNB is increasing, and that drug resistance may be a factor ( 7 , 18 , 21 , 22 ). However, many studies have also reported a predominance of GPB in BSI ( 3 - 5 , 16 , 19 , 23 - 26 ). Resistant bacterial strains are relatively rare in Japan, and most Japanese studies in this field have reported a predominance of GPB in BSI ( 3 , 5 , 16 , 19 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…Enterococcus spp. are frequently observed and are being increasingly frequently reported as causative agents of BSI after HSCTs, constituting major causative pathogens of BSI in patients on IEAT ( 18 - 20 , 26 , 28 , 29 ). Therefore, for the second HSCT, Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

et al. 2023

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Objective Infections after a second hematopoietic stem cell transplantation (HSCT) occur commonly and are associated with high mortality. However, studies on bloodstream infection (BSI) after a second HSCT are lacking. We therefore evaluated the details of BSI after a second HSCT. Methods We retrospectively evaluated the incidence, etiology, risk factors, and outcomes of BSI after a second HSCT. Patients Fifty-two adult patients with hematological malignancies who underwent allogeneic HSCT, including cord blood transplantation (CBT; n=33), as the second transplantation were enrolled. The second transplantation was limited to allogeneic HSCT. Patients who underwent HSCT for graft failure were excluded. Results The median HSCT interval was 438 (range: 39-3,893) days. Overall, 31 (59.6%) patients received autologous HSCT as the first HSCT. The cumulative incidence of BSI was 40.4% at 100 days after the second HSCT, with Gram-positive bacteria accounting for the majority (30.8%) of pathogens. Overall, 92.0% of BSIs occurred during the pre-engraftment period, and Enterococcus faecium accounted for 29.6% of pathogens. On a multivariate analysis, CBT was most closely associated with pre-engraftment BSI after the second HSCT (hazard ratio: 3.43, 95% confidence interval: 1.05-11.23, p=0.042). The 1-year survival rate after the second HSCT was lower in patients with BSI than in patients without BSI (p=0.10). Conclusion BSI is common after a second HSCT, especially with CBT. During the pre-engraftment period, BSI caused by pathogens such as E. faecium should be anticipated and appropriately treated to improve transplant outcomes.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

et al. 2023

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“…Antibiotic exposure over time increases the risk of MDROs [74,75]. MDRO infections in immunocompromised individuals are hard to treat and impact morbidity and mortality [76,77]. Many of these patients have prior antibiotic exposure due to their underlying disease, leading to antibiotic selection pressure.…”

Section: Harm Of Unnecessary Antimicrobials In Hematopoietic Cell Tra...mentioning

confidence: 99%

Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated?

Shahid

Epstein

2023

Current Opinion in Infectious Diseases

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Purpose of review Fever is a common manifestation of both infectious and noninfectious processes in recipients of hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy. Understanding the diverse causes of fever in these settings allows for accurate diagnosis and optimal use of antibiotics. Recent findings Herein we review common noninfectious syndromes seen in HCT and CAR-T recipients and discuss best practices in the management of these complex clinical scenarios regarding diagnosis and antibiotic use. In recent years, adverse effects of antimicrobials have highlighted the importance of antimicrobial stewardship in HCT and CAR-T patients, and an antibiotic de-escalation strategy is a safe and important tool in mitigating these adverse events, even in patients with ongoing neutropenia who become afebrile without a known infection. Common adverse events associated with antibiotics include an increased risk of Clostridiodes difficile infection (CDI), a higher incidence of multidrug-resistant organisms (MDROs), and microbiome dysbiosis. Summary Clinicians should be aware of noninfectious causes of fever in these immunocompromised patients and utilize best antibiotic practices while managing these patients.

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“…A single‐center longitudinal study from Spain noted that the proportion of ESBL production among Enterobacterales bloodstream isolates in HCT recipients has increased over time, from 0% in 1998–2002, to 8% in 1998–2002, to 17% 2003–2007, to 34% in 2008–2012, and 21% in 2013–2017 42 . Mortality after ESBL‐E BSI in patients with hematologic malignancies and HCT recipients is high, 34–38,43–45 and some studies have noted increased mortality after ESBL‐E BSIs compared to non‐ESBL‐E BSIs 34,46,47 . Although routine empirical therapy with a carbapenem would optimally treat patients infected with ESBL‐E BSIs, this is not an optimal strategy because routine empirical carbapenem use would likely exacerbate the emerging problem of CRE.…”

Section: Resistant Bacteria That Decrease the Effectiveness Of Empiri...mentioning

confidence: 99%

Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients

Gottesdiener,

Satlin

2023

Transplant Infectious Dis

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Patients with hematologic malignancies and hematopoietic cell transplant (HCT) recipients are at high risk of developing bacterial infections. These patients may suffer severe consequences from these infections if they do not receive immediate effective therapies, and thus are uniquely threatened by antimicrobial‐resistant bacteria. Here, we outline how the emergence of specific resistant bacteria threatens the effectiveness of established approaches to prevent and treat infections in this population. The emergence of fluoroquinolone resistance among Enterobacterales and viridans group streptococci may decrease the effectiveness of fluoroquinolone prophylaxis during neutropenia. The emergence of Enterobacterales that produce extended‐spectrum β‐lactamases or carbapenemases and of increasingly resistant Pseudomonas aeruginosa may result in neutropenic patients experiencing delayed time to active antibacterial therapy, and consequently worse clinical outcomes. The ability to select targeted antibacterial therapies after the availability of susceptibility data may be limited in patients infected with metallo‐β‐lactamase‐producing Enterobacterales and difficult‐to‐treat P. aeruginosa. Vancomycin‐resistant enterococci and Stenotrophomonas maltophilia can cause breakthrough infections in patients already being treated with broad‐spectrum β‐lactam antibiotics. Resistance can also limit the ability to provide oral stepdown antibacterial therapy for patients who could otherwise be discharged from hospitalization. We also outline strategies that have the potential to mitigate the negative impact of antimicrobial resistance, including interventions based on active screening for colonization with resistant bacteria and the use of novel rapid diagnostic assays. Additional research is needed to better understand how these strategies can be leveraged to combat the emerging crisis of antimicrobial resistance in patients with hematologic malignancies and HCT recipients.

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Risk Factors for Mortality in Hematopoietic Stem Cell Transplantation Recipients with Bloodstream Infection: Points To Be Addressed by Future Guidelines

Cited by 13 publications

References 19 publications

Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

Noninfectious causes of fever in hematologic malignancies. Are antibiotics still indicated?

Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients

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