title: Defining incidence, risk factors, and impact on survival of central line-associated blood stream infections following hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome.
abstract: Central line-associated blood stream infections (CLABSI) commonly complicate the care of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) after allogeneic stem cell transplantation (HCT). We developed a modified CLABSI (MCLABSI) definition that attempts to exclude pathogens usually acquired because of disruption of mucosal barriers during the vulnerable neutropenic period following HCT that are generally included under the original definition (OCLABSI). We conducted a retrospective study of all AML and MDS patients undergoing HCT between August 2009 and December 2011 at the Cleveland Clinic (N = 73), identifying both OCLABSI and MCLABSI incidence. The median age at transplantation was 52 years (range, 16 to 70); 34 had a high (≥3) HCT comorbidity index (HCT-CI); 34 received bone marrow (BM), 24 received peripheral stem cells (PSC), and 15 received umbilical cord blood cells (UCB). Among these 73 patients, 23 (31.5%) developed OCLABSI, of whom 16 (69.6%) died, and 8 (11%) developed MCLABSI, of whom 7 (87.5%) died. OCLABSI was diagnosed a median of 9 days from HCT: 5 days (range, 2 to 12) for UCB and 78 days (range, 7 to 211) for BM/PSC (P < .001). MCLABSI occurred a median of 12 days from HCT, with similar earlier UCB and later BM/PSC diagnosis (P = .030). Risk factors for OCLABSI in univariate analysis included CBC (P < .001), human leukocyte antigen (HLA)-mismatch (P = .005), low CD34(+) count (P = .007), low total nucleated cell dose (P = .016), and non-Caucasian race (P = .017). Risk factors for OCLABSI in multivariable analysis were UCB (P < .001) and high HCT-CI (P = .002). There was a significant increase in mortality for both OCLABSI (hazard ratio, 7.14; CI, 3.31 to 15.37; P < .001) and MCLABSI (hazard ratio, 6.44; CI, 2.28 to 18.18; P < .001). CLABSI is common and associated with high mortality in AML and MDS patients undergoing HCT, especially in UCB recipients and those with high HCT-CI. We propose the MCLABSI definition to replace the OCLABSI definition, given its greater precision for identifying preventable infection in HCT patients.
authors: Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland, OH, USA. lukenbj@ccf.org
authors: Joshua
authors: J
authors: Lukenbill
authors: Lisa
authors: L
authors: Rybicki
authors: Mikkael A
authors: MA
authors: Sekeres
authors: Muhammad Omer
authors: MO
authors: Zaman
authors: Alexander
authors: A
authors: Copelan
authors: Housam
authors: H
authors: Haddad
authors: Thomas
authors: T
authors: Fraser
authors: Megan J
authors: MJ
authors: DiGiorgio
authors: Rabi
authors: R
authors: Hanna
authors: Hien
authors: H
authors: Duong
authors: Brian
authors: B
authors: Hill
authors: Matt
authors: M
authors: Kalaycio
authors: Ronald
authors: R
authors: Sobecks
authors: Brian
authors: B
authors: Bolwell
authors: Edward
authors: E
authors: Copelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000517:prevention & control; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult