title: Incidence, risk factors, and outcome of bacteremia following autologous hematopoietic stem cell transplantation in 720 adult patients.
abstract: Bacteremia is the most frequent infectious complication during neutropenia in patients receiving autologous hematopoietic stem cell transplantation (ASCT). The objective of this study was to analyze the incidence, characteristics, risk factors, and outcome of bacteremia during the early period after ASCT. A total of 720 patients undergoing ASCT in two observational prospective consecutive multicenter studies of the Programa Español para el Tratamiento de las Hemopatías group were analyzed. Bacteremia occurred in 20 % of patients. Coagulase-negative Staphylococcus was the most frequent (66 %) among the gram-positive agents and Escherichia coli (49 %) among the gram-negative agents. Multivariate analysis showed that the length of neutropenia <1 × 10(9)/L (more than 9 days) [relative risk (RR) of 2.6, p < 0.001] was the sole risk factor for overall bacteremia. We identified the length of neutropenia <1 × 10(9)/L (more than 9 days) (RR 4.98, p < 0.001) and the use of prophylactic fluoroquinolones (RR 0.46, p < 0.01) as specific risk factors for gram-negative bacteremia. Risk factors for gram-positive bacteremia were the use of total parenteral nutrition (RR 1.92, p < 0.01) and deep neutropenia (<0.1 × 10(9)/L), with duration over 5 days (RR 1.67, p < 0.027). Bacteremia showed an increased morbidity with no impact on neither overall nor infectious related mortality. The identification of such risk factors may be helpful to implement prophylactic and therapeutic risk-adapted strategies to reduce the incidence of bacteremia in ASCT.
authors.affiliation: Clinical Research Unit, Hematology Department, Hospital Universitari i Politècnico la Fe, Boulevard Sud, 46026, Valencia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Lourdes
authors.initials: L
authors.lastname: Vazquez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Montserrat
authors.initials: M
authors.lastname: Batlle
authors.forename: Ángela
authors.initials: Á
authors.lastname: Figuera
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: Guillermo
authors.initials: G
authors.lastname: Debén
authors.forename: Cristina
authors.initials: C
authors.lastname: Perez-Lopez
authors.forename: Raimundo
authors.initials: R
authors.lastname: García
authors.forename: Pedro
authors.initials: P
authors.lastname: Rosique
authors.forename: Esperanza
authors.initials: E
authors.lastname: Lavilla
authors.forename: Adriana
authors.initials: A
authors.lastname: Gascón
authors.forename: David
authors.initials: D
authors.lastname: Martínez-Cuadrón
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D064592:Autografts; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones