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Bacteraemia post-autologous haematopoietic stem cell transplantation in the absence of antibacterial prophylaxis: a decade’s experience from Lebanon

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Abstract

Purpose

In this study, we assessed the incidence, contributing factors and outcome of prolonged neutropenia above 7 days and of bacteraemia in patients with lymphoma and multiple myeloma who underwent autologous haematopoietic stem cell transplantation (AHSCT) without antibacterial prophylaxis.

Methods

This is a retrospective chart review of 190 adult patients who underwent AHSCT between 2005 and 2015 at a Lebanese hospital.

Results

Neutropenia of 7 days duration and longer was documented in 66% of the patient population. Through univariate analysis, patients with lymphoma were significantly more likely to have prolonged neutropenia (≥ 7 days) compared to those with myeloma. Mucositis above grade 3, diarrhoea and fever were more likely to occur in patients with prolonged neutropenia. Bacteraemia was documented in 12.6% of the patients. Total mortality rate was 3.7%, and that attributed to bacteraemia was 12.5% in the bacteraemia subgroup. Among bacterial isolates recovered from clinical specimens (89 isolates), 70% were Gram-negative, of which 57% were fluoroquinolone susceptible. Ninety-five percent of the Gram-negative bacteria causing bacteraemia were susceptible to fluoroquinolones.

Conclusion

Bacterial pathogens causing bacteraemia were still highly susceptible to fluoroquinolones, despite the high prevalence of fluoroquinolone-resistant strains in the general bacterial ecology. Accordingly, the pertinence of fluoroquinolone prophylaxis in the AHSCT setting warrants further investigation. Moreover, continuous surveillance of local antibiograms in this patient population has become a must in an era of preponderant antibiotic resistance.

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Acknowledgements

We would like to acknowledge Miss Karen Abdallah for providing technical assistance.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Tarik Al Jadida, Riad El-Solh, PO Box 11-6301, Beirut, 1107 2210, Lebanon

    Rima Moghnieh

  2. Pharmacy Department, Makassed General Hospital, Beirut, Lebanon

    Dania Abdallah & Lyn Awad

  3. Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon

    Tamima Jisr

  4. Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon

    Anas Mugharbil, Ali Youssef & Ahmad Ibrahim

  5. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Hani Tamim

  6. Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon

    Samer Khaldieh

  7. Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon

    Oula Massri, Najat Rashini & Youssef Hamdan

Authors
  1. Rima Moghnieh
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  2. Dania Abdallah
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  3. Lyn Awad
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  4. Tamima Jisr
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  5. Anas Mugharbil
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  6. Ali Youssef
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  7. Hani Tamim
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  8. Samer Khaldieh
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  9. Oula Massri
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  10. Najat Rashini
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  12. Ahmad Ibrahim
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Corresponding author

Correspondence to Rima Moghnieh.

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Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

Makassed General Hospital Institutional Review Board committee approved this study.

Informed consent

No informed consent was required due to the retrospective nature of this study. During the data collection phase, a special form was used where patient initials and case numbers were only included. At a later stage, a different number was assigned to each of our cases to safeguard patient privacy.

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Moghnieh, R., Abdallah, D., Awad, L. et al. Bacteraemia post-autologous haematopoietic stem cell transplantation in the absence of antibacterial prophylaxis: a decade’s experience from Lebanon. Infection 46, 823–835 (2018). https://doi.org/10.1007/s15010-018-1200-y

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  • DOI: https://doi.org/10.1007/s15010-018-1200-y

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