title: Acute gastrointestinal graft-vs-host disease is associated with increased enteric bacterial bloodstream infection density in pediatric allogeneic hematopoietic cell transplant recipients.
abstract: BACKGROUND
  Bacterial septicemia remains the leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (AlloHCT). While murine studies have found acute gastrointestinal graft-vs-host disease (aG-GVHD) to be associated with increased incidence of enteric bacterial bloodstream infections (EB-BSI), this association has not been studied in humans. We hypothesized that in patients who developed aG-GVHD, the EB-BSI density after onset of aG-GVHD would be higher than before onset and higher than in patients without acute GVHD (aGVHD).
  
  
  METHODS
  We retrospectively reviewed data collected on 264 pediatric AlloHCT recipients with malignant and nonmalignant disease. We calculated and compared EB-BSI densities in the following 3 subgroups: patients without aGVHD and patients with aG-GVHD, both before and after onset of aG-GVHD. We also examined the effect of aG-GVHD onset on the first episode of EB-BSI using Cox proportional hazards models.
  
  
  RESULTS
  The overall incidence of aG-GVHD was 28.8% (n = 76). Analyses done both at 120 and 180 days post-AlloHCT showed that the EB-BSI density increased after aG-GVHD onset (0.95 infections/person-year before aG-GVHD vs 2.7 infections/person-year after aG-GVHD at day 120 [P = .006]; 0.95 infections/person-year before aG-GVHD vs 2.26 infections/person-year after aG-GVHD at day 180 [P = .033]). On multivariate analysis, the onset of aG-GVHD had a positive hazard ratio of 1.47 (P = .077) on time to first EB-BSI.
  
  
  CONCLUSIONS
  Our results support the theory that aG-GVHD predisposes pediatric AlloHCT recipients to EB-BSI. Prophylactic agents such as probiotics should be studied prospectively in patients with aG-GVHD.
authors.affiliation: Department of Pediatrics.
authors.forename: Anya
authors.initials: A
authors.lastname: Levinson
authors.affiliation: Department of Pediatrics.
authors.forename: Kerice
authors.initials: K
authors.lastname: Pinkney
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York.
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Pediatrics.
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.affiliation: Department of Pediatrics.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Kung
authors.affiliation: Department of Pediatrics.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Foca
authors.affiliation: Department of Pediatrics.
authors.forename: Diane
authors.initials: D
authors.lastname: George
authors.affiliation: Department of Pediatrics.
authors.forename: James H
authors.initials: JH
authors.lastname: Garvin
authors.affiliation: Department of Pediatrics.
authors.forename: Jean
authors.initials: J
authors.lastname: Sosna
authors.affiliation: Department of Pediatrics.
authors.forename: Esra
authors.initials: E
authors.lastname: Karamehmet
authors.affiliation: Department of Pediatrics.
authors.forename: Chalitha
authors.initials: C
authors.lastname: Robinson
authors.affiliation: Department of Pediatrics.
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects*
keywords: AlloHCT; BSI; GVHD