title: Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen.
abstract: The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day -7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P = .04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR, .6; 95% CI, .5 to .9; P = .002). A higher CD8(+) cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR, .1; 95% CI, .02 to .7; P = .02). The gram-negative rod (GNR) to gram-positive bacteria ratio was .9 before day +30 and 1.6 thereafter (P = .03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P = .03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period.
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain. Electronic address: sanz_jai@gva.es.
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cano
authors.affiliation: Department of Microbiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Eva M
authors.initials: EM
authors.lastname: González-Barberá
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Arango
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Jheremy
authors.initials: J
authors.lastname: Reyes
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Lorenzo
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Isidro
authors.initials: I
authors.lastname: Jarque
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: López
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Arilla
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Aima
authors.initials: A
authors.lastname: Lancharro
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardó
authors.affiliation: Department of Microbiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: López-Hontangas
authors.affiliation: Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Salavert
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
authors.affiliation: Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D061349:Unrelated Donors
keywords: Bloodstream infections; Engraftment; Nonrelapse mortality; Umbilical cord blood transplantation