Risk Factors and Outcomes of Infections by Multidrug-Resistant Gram-Negative Bacteria in Patients Undergoing Hematopoietic Stem Cell Transplantation.
The objective of this study was to determine risk factors and outcomes of infections by multidrug-resistant gram-negative (MDR GN) bacteria in 241 recipients of hematopoietic stem cell transplantation (HSCT). The cumulative incidence of infections was 10.5% (95% CI, 12.0% to 25.8%), with 57% of infections occurring during the period of severe neutropenia (neutrophil count < .1 × 106/L). In multivariate analysis, allogeneic transplant and colonization with MDR GN bacteria at admission to the transplant unit were significantly associated with an increased risk of infection. Although we observed neither transplant-related mortality (TRM) nor deaths due to infections by MDR GN bacteria after autologous transplant, in the allogeneic setting a significant difference was reported in terms of overall survival (OS) and TRM between patients who developed infections and those who did not (1-year OS, 39% versus 68%; 1-year TRM, 42% versus 19%). In multivariate analysis, refractory disease and development of grades III to IV graft-versus-host disease (GVHD) were factors that affected both TRM and OS, whereas occurrence of infections by MDR GN pathogens significantly reduced OS. We conclude that eligibility to allogeneic HSCT in MDR GN bacteria carriers should be carefully evaluated together with all other factors that independently influence outcome (disease status, donor, and GVHD risk).
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy. Electronic address: francesca.patriarca@asuiud.sanita.fvg.it.
Francesca
F
Patriarca
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Chiara
C
Cigana
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Dozzo
D
Massimo
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Davide
D
Lazzarotto
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Antonella
A
Geromin
Istituto di Statistica, Dipartimento di Ricerche Mediche e Biologiche, Università di Udine, Udine, Italy.
Miriam
M
Isola
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Marta Lisa
ML
Battista
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Marta
M
Medeot
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Michela
M
Cerno
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Alessandra
A
Sperotto
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Anna
A
Candoni
Clinica di Malattie Infettive, ASUI di Udine, Udine, Italy.
Massimo
M
Crapis
Istituto di Microbiologia, Azienda Sanitaria-Universitaria Integrata (ASUI) di Udine, Udine, Italy.
Assunta
A
Sartor
Istituto di Microbiologia, Azienda Sanitaria-Universitaria Integrata (ASUI) di Udine, Udine, Italy.
Claudio
C
Scarparo
Clinica di Malattie Infettive, ASUI di Udine, Udine, Italy.
Matteo
M
Bassetti
Clinica Ematologica, Dipartimento di Scienze Sperimentali e Cliniche, Università di Udine, Udine, Italy.
Renato
R
Fanin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents
Gut colonization; Hematopoietic stem cell transplantation; Infections; Multidrug-resistant gram-negative bacteria