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Incidence, risk factors, and outcome of bacteremia following autologous hematopoietic stem cell transplantation in 720 adult patients

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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 × 109/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 × 109/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 × 109/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.

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References

  1. Jantunen E, Itälä M, Lehtinen T et al (2006) Early treatment-related mortality in adult autologous stem cell transplant recipients: a nation-wide survey of 1482 transplanted patients. Eur J Haematol 76:245–250

    Article  CAS  PubMed  Google Scholar 

  2. Weaver CH, Schwartzberg LS, Hainsworth J et al (1997) Treatment-related mortality in 1000 consecutive patients receiving high-dose chemotherapy and peripheral blood progenitor cell transplantation in community cancer centers. Bone Marrow Transplant 7:671–678

    Article  Google Scholar 

  3. De la Rubia J, Saavedra S, Sanz GF et al (2001) Transplant-related mortality in patients older than 60 years undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 27(1):21–25

    Article  PubMed  Google Scholar 

  4. Nosanchuk JD, Sepkowitz KA, Pearse RN et al (1996) Infectious complications of autologous bone marrow and peripheral stem cell transplantation for refractory leukemia and lymphoma. Bone Marrow Transplant 18(2):355–359

    CAS  PubMed  Google Scholar 

  5. Gil L, Styczynski J, Komarnicki M (2007) Infectious complication in 314 patients after high-dose therapy and autologous hematopoietic stem cell transplantation: risk factors analysis and outcome. Infection 35:421–427

    Article  CAS  PubMed  Google Scholar 

  6. Mossad SB, Longworth DL, Goormastic M et al (1996) Early infectious complications in autologous bone marrow transplantation: a review of 219 patients. Bone Marrow Transplant 18(2):265–271

    CAS  PubMed  Google Scholar 

  7. Salazar R, Solá C, Maroto P et al (1999) Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 23(1):27–33

    Article  CAS  PubMed  Google Scholar 

  8. Kolbe K, Domkin D, Derigs HG et al (1997) Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 19(2):143–147

    Article  CAS  PubMed  Google Scholar 

  9. Wimperis JZ, Baglin TP, Marcus RE, Warren RE (1991) An assessment of the efficacy of antimicrobial prophylaxis in bone marrow autografts. Bone Marrow Transplant 8(5):363–367

    CAS  PubMed  Google Scholar 

  10. Reich G, Mapara MY, Reichardt P et al (2001) Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant 27(5):525–529

    Article  CAS  PubMed  Google Scholar 

  11. Puig N, de la Rubia J, Jarque I et al (2007) A study of incidence and characteristics of infections in 476 patients from a single center undergoing autologous blood stem cell transplantation. Int J Hematol 86(2):186–192

    Article  PubMed  Google Scholar 

  12. Sanz MA, López J, Lahuerta JJ et al (2002) Cefepime plus amikacin versus piperacillin-tazobactam plus amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia: results of an open, randomized, multicentre trial. J Antimicrob Chemother 50(1):79–88

    Article  CAS  PubMed  Google Scholar 

  13. De la Rubia J, Montesinos P, Martino R et al (2009) Imipenem/cilastatin with or without glycopeptide as initial antibiotic therapy for recipients of autologous stem cell transplantation: results of a Spanish multicenter study. Biol Blood Marrow Transplant 15(4):512–516

    Article  PubMed  Google Scholar 

  14. Pizzo PA, Armstrong D, Bodey G et al (1990) From the immunocompromised host society: the design, analysis, and reporting of clinical trials on the empirical antibiotic management of the neutropenic patient: report of a consensus panel. J Infect Dis 161:397–401

    Article  Google Scholar 

  15. Hughes WT, Pizzo PA, Wade JC et al (1992) Evaluation of New anti-infective drugs for the treatment of febrile episodes in neutropenic patients. Clin Infect Dis 15:S206–S215

    Article  PubMed  Google Scholar 

  16. Link H, Maschmeyer G, Meyer P et al (1994) Interventional antimicrobial therapy in febrile neutropenic patients. Study Group of the Paul Ehrlich Society for Chemotherapy. Ann Hematol 69(5):231–243

    Article  CAS  PubMed  Google Scholar 

  17. Mermel LA, Farr BM, Sherertz RJ et al (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32(9):1249–1272

    Article  CAS  PubMed  Google Scholar 

  18. Dixon WJ, Brown MB, Engelman L, Jeinrich RI (1994) BMDP statistical analysis software. University of California, Berkeley

    Google Scholar 

  19. De Pauw BE, Deresinski SC, Feld R et al (1994) Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. The Intercontinental Antimicrobial Study Group. Ann Intern Med 120(10):834–844

    Article  PubMed  Google Scholar 

  20. Freifeld AG, Walsh T, Marshall D et al (1995) Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem. J Clin Oncol 13:165–176

    CAS  PubMed  Google Scholar 

  21. Klumpp TR, Mangan KF, Goldberg SL et al (1995) Granulocyte colony-stimulating factor accelerates neutrophil engraftment following peripheral-blood stem-cell transplantation: a prospective, randomized trial. J Clin Oncol 13:1323–1327

    CAS  PubMed  Google Scholar 

  22. Peters WP, Rosner G, Ross M et al (1993) Comparative effects of granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) on priming peripheral blood progenitor cells for use with autologous bone marrow after high-dose chemotherapy. Blood 81:1709–1719

    CAS  PubMed  Google Scholar 

  23. Hornedo J, Solá C, Solano C et al (2002) The role of granulocyte colony-stimulating factor (G-CSF) in the post-transplant period. Bone Marrow Transplant 29(9):737–743

    Article  CAS  PubMed  Google Scholar 

  24. Shimazaki C, Oku N, Uchiyama H et al (1994) Effect of granulocyte colony-stimulating factor on hematopoietic recovery after peripheral blood progenitor cell transplantation. Bone Marrow Transplant 13(3):271–275

    CAS  PubMed  Google Scholar 

  25. Eleutherakis-Papaiakovou E, Kostis E, Migkou M et al (2010) Prophylactic antibiotics for the prevention of neutropenic fever in patients undergoing autologous stem-cell transplantation: results of a single institution, randomized phase 2 trial. Am J Hematol 85:863–867

    Article  CAS  PubMed  Google Scholar 

  26. Offidani M, Corvatta L, Olivieri A, Rupoli S, Frayfer J, Mele A et al (1999) Infectious complications after autologous peripheral blood progenitor cell transplantation followed by G-CSF. Bone Marrow Transplant 24(10):1079–1087

    Article  CAS  PubMed  Google Scholar 

  27. Auner HA, Sill HS, Mulabecirovic AM et al (2002) Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 81:374–377

    Article  CAS  PubMed  Google Scholar 

  28. Freifeld AG, Bow EJ, Sepkowitz KA et al (2010) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011(52):427–431

    Google Scholar 

  29. Leibovici L, Paul M, Cullen M et al (2006) Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions. Cancer 107:1743–1751

    Article  CAS  PubMed  Google Scholar 

  30. Sheean PM, Freels SA, Helton WS, Braunschweig CA (2006) Adverse clinical consequences of hyperglycemia from total parenteral nutrition exposure during hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 12:656–664, Abstract

    Article  PubMed  Google Scholar 

  31. Marena C, Zecca M, Carenini ML et al (2001) Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality. Infection Control and Hospital Epidemiol 22:510–517

    Article  CAS  Google Scholar 

  32. Scolapio JS, Tarrosa VB, Stoner GL et al (2002) Audit of nutrition support for hematopoietic stem cell transplantation at a single institution. Mayo Clin Proc 77:654–659

    Article  PubMed  Google Scholar 

  33. Weisdorf S, Hofland C, Sharp HL et al (1984) Total parenteral nutrition in bone marrow transplantation: a clinical evaluation. J Pediatr Gastroenterol Nutr 3(1):95–100

    Article  CAS  PubMed  Google Scholar 

  34. Weisdorf SA, Lysne J, Wind D et al (1987) Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation. Transplantation 43(6):833–8

    CAS  PubMed  Google Scholar 

  35. Finney SJ, Zekveld C, Elia A, Evans TW (2003) Glucose control and mortality in critically Ill patients. JAMA 290:2041–2047

    Article  CAS  PubMed  Google Scholar 

  36. Krinsley JS (2003) Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically Ill patients. Mayo Clin Proc 78:1471–1478

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interests.

Author information

Authors and Affiliations

  1. Clinical Research Unit, Hematology Department, Hospital Universitari i Politècnico la Fe, Boulevard Sud, 46026, Valencia, Spain

    José Luis Piñana, Pau Montesinos, David Martínez-Cuadrón & Miguel Ángel Sanz

  2. Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Rodrigo Martino

  3. Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain

    Lourdes Vazquez

  4. Hematology Department, Hospital Clinic de Barcelona, Barcelona, Spain

    Montserrat Rovira

  5. Hematology Department, Hospital Ramon y Cajal, Madrid, Spain

    Javier López

  6. Hematology Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

    Montserrat Batlle

  7. Hematology Department, Hospital La Princesa, Madrid, Spain

    Ángela Figuera

  8. Hematology Department, Hospital Universitari Vall D’Hebron, Barcelona, Spain

    Pere Barba

  9. Hematology Department, Hospital 12 de Octubre, Madrid, Spain

    Juan José Lahuerta

  10. Hematology Department, Hospital Juan Canalejo, A Coruña, Spain

    Guillermo Debén

  11. Hematology Department, Hospital San Carlos, Madrid, Spain

    Cristina Perez-Lopez

  12. Hematology Department, Hospital General de Castellón, Castellón, Spain

    Raimundo García

  13. Hematology Department, Hospital Virgen de la Arrixaca, Murcia, Spain

    Pedro Rosique

  14. Hematology Department, Complejo Hospitalario Xeral-Calde, Lugo, Spain

    Esperanza Lavilla

  15. Hematology Department, Institut Valenciá d’Oncologia, Valencia, Spain

    Adriana Gascón

  16. Hematology Department, Hospital Clínico Universitario, Valencia, Spain

    José Luis Piñana

  17. Medicine department, Universitat de Valencia, Valencia, Spain

    Miguel Ángel Sanz

Authors
  1. José Luis Piñana
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  2. Pau Montesinos
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  3. Rodrigo Martino
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  4. Lourdes Vazquez
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  5. Montserrat Rovira
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  9. Pere Barba
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  14. Pedro Rosique
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  15. Esperanza Lavilla
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  16. Adriana Gascón
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  17. David Martínez-Cuadrón
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  18. Miguel Ángel Sanz
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Corresponding author

Correspondence to Pau Montesinos.

Additional information

José Luis Piñana and Pau Montesinos contributed equally to this manuscript.

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Piñana, J.L., Montesinos, P., Martino, R. et al. Incidence, risk factors, and outcome of bacteremia following autologous hematopoietic stem cell transplantation in 720 adult patients. Ann Hematol 93, 299–307 (2014). https://doi.org/10.1007/s00277-013-1872-4

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  • DOI: https://doi.org/10.1007/s00277-013-1872-4

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