The incidence, risk factors and outcomes of early bloodstream infection in patients with malignant hematologic disease after unrelated cord blood transplantation: a retrospective study

Abstract

BackgroundBloodstream infection (BSI) is one of the major causes of morbidity and mortality for patients undergoing hematopoietic stem cell transplantation (HSCT). The unrelated cord blood transplantation (UCBT) can provided opportunities for patients without suitable donors for bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT), while few studies have addressed BSI after UCBT. The aim of this study was to analyse the incidence and risk factors of BSI, causative organisms, microbial resistance, and its impact on the clinical outcomes and survival of patients.MethodsThere are 336 patients, were divided into two groups depending on whether developing BSI. Demographic characteristics, laboratory data, and clinical outcome were compared between different groups. The risk factors of BSI was examined using logistic regression and the survival was examined using the Kaplan-Meier method and log-rank test.ResultsNinety-two patients (27.4%) developed early BSI with 101 pathogenic bacteria isolated, and the median day of developing initial BSI was 4.5 d. Gram-negative bacteria were the most common isolate (60, 59.4%), followed by Gram-positive bacteria (40, 39.6%) and fungi (1, 1.0%). Thirty-seven (36.6%) isolates were documented as having multiple drug resistance (MDR). Myeloid malignancies, conditioning regimens including total body irradiation (TBI), and prolonged neutropenia were identified as the independent risk factors for early BSI. The 3-year OS was 59.9% versus 69.2% in the BSI group and no-BSI group (P = 0.0574), respectively. The 3-year OS of the MDR group was significantly lower than that of the non-BSI group (51.1% versus 69.2%, p = 0.013).ConclusionsOur data indicate that the incidence of early BSI after UCBT was high, especially in patients with myeloid disease and a conditioning regimen including TBI and prolonged neutropenia. Early BSI with MDR after UCBT had a negative impact on long-term survival.

Clinical Analysis of Bloodstream Infections During Agranulocytosis After Allogeneic Hematopoietic Stem Cell Transplantation

“…Peripheral blood combined with bone marrow transplantation, hematopoietic implantation is relatively fast, which may be the reason for the lower incidence of BSIs in this group of patients, relative to peripheral blood and cord blood transplantation. 31–33 …”

Microbiology of Bloodstream Infections in Children After Hematopoietic Stem Cell Transplantation: A Single-Center Experience Over Two Decades (1997–2017)

“…This incidence is comparable to other pediatric and adult cohorts, with cumulative incidences in pediatric cohorts ranging broadly from 15% to 65% [ 1 , 4 , 19–22 ]. Previous studies reported an increase in BSI in association with specific risk factors, including allogeneic HSCT, unrelated HSCT donor, myeloablative conditioning, total body irradiation, and delayed engraftment [ 1 , 20 , 23–25 ]. Although we did not directly assess the contribution of these factors to the risk of BSI, our cohort is a unique population that has a high prevalence of several of these risk factors.…”

Emergency Combination of Four Drugs for Bloodstream Infection Caused by Carbapenem-Resistant Enterobacteriaceae in Severe Agranulocytosis Patients with Hematologic Malignancies after Hematopoietic Stem Cell Transplantation

“…Multidrug-resistant (MDR) Enterobacteriaceae, including extended-spectrum β-lactamase (ESBL) bacteria and carbapenem-resistant Enterobacteriaceae (CRE), is a great threat to recipients in HSCT [1]. BSI caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) after transplantation, mostly including Escherichia coli and Klebsiella pneumoniae [2], has shown a negative impact on long-term survival in transplantation [3]. Herein, we present four cases in which CRE was detected in neutropenic patients with hematologic malignancies and focus on the treatment of MDR bacteria.…”