BACTERIAL BLOOD STREAM INFECTIONS NEGATIVELY IMPACT ON OUTCOME OF PATIENTS TREATED WITH ALLOGENEIC STEM CELL TRANSPLANTATION: 6 YEARS SINGLE-CENTRE EXPERIENCE

Michele Malagola
  • Michele Malagola
    Chair of Hematology, Bone Marrow Transplant Unit, Clinical and Experimental Sciences Department, University of Brescia, Italy, | michelemalagola@yahoo.it

Abstract

Background: Blood stream infections (BSIs) represent a major complication of allo-SCT and are a major cause of morbidity and mortality during and after bone marrow aplasia.

Objectives: The objective of this study was to describe the incidence and outcome of BSIs in a cohort of patients submitted to allo-SCT, in order to track changes of the epidemiology and bacteria resistance.

Methods: We retrospectively analyzed the microbiological data of 162 patients allotransplanted in Brescia University Hospital, over a period of 6 years.

Results: Eighty patients experienced a BSIs for a total of 119 isolates. In 77 cases (65%) a Gram positive bacteria was isolated, being coagulase negative Staphilococci the most frequent species (77% of the cases). In 42 cases (35%) a Gram negative bacteria was isolated (E. coli 57% and P. aeruginosa 24%). Fluoroquinolones resistance was frequent (90% for S. epidermidis, 92% for E. coli, 90% for P. aeruginosa). Methycillin resistance of S. epidermidis was 100%, 76% of E. coli were ESBL positive and among P. aeruginosa resistance to carbapenems was 40%. The 2 years overall survival of patients with BSIs vs patients without BSIs was 46% vs 60% (HR1,48, p=0,07). P. areuginosa and E. coli were the species with the highest mortality (50% and 33%, respectively).

Conclusions: These data confirms that BSIs, mainly sustained by Gram positive bacteria, are frequent in allotransplanted patients (50% of the cases) and may influence the outcome of allotransplanted patients, being antibiotics resistance highly frequent among these bacteria.

Keywords

bone marrow transplantation,bacterial infections, antimicrobical resistance

Full Text:

PDF
HTML
Submitted: 2017-02-08 09:30:36
Published: 2017-06-20 00:00:00
Search for citations in Google Scholar
Related articles: Google Scholar

References

Williamson EC, Millar MR, Steward CG, Cornish JM, Foot AB, Oakhill A, Pamphilon DH, Reeves B, Caul EO, Warnock DW, Marks DI. Infections in adults undergoing unrelated donor bone marrow transplantation. Br J Haematol 1999; 104:560-8.

Ninin E, Milpied N, Moreau P, André-Richet B, Morineau N, Mahé B, Vigier M, Imbert BM, Morin O, Harousseau JL, Richet H. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001; 33:41-7.

Marena C, Zecca M, Carenini ML, Bruschi A, Bassi ML, Olivieri P, Azzaretti S, Locatelli F. Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality. Infect Control Hosp Epidemiol 2001; 22:510-7.

Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR. Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant 2007 ;40:63-70.

Almyroudis NG, Fuller A, Jakubowski A, Sepkowitz K, Jaffe D, Small TN, Kiehn TE, Pamer E, Papanicolaou GA. Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients. Transpl Infect Dis 2005 ;7:11-7.

Collin BA, Leather HL, Wingard JR, Ramphal R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001 ;33:947-53.

Cappellano P, Viscoli C, Bruzzi P, Van Lint MT, Pereira CA, Bacigalupo A. Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantion. New Microbiol 2007 ;30:89-99.

Ortega M, Rovira M, Almela M, Marco F, de la Bellacasa JP, Martínez JA, Carreras E, Mensa J. Bacterial and fungal bloodstream isolates from 796 hematopoietic stem cell transplant recipients between 1991 and 2000. Ann Hematol 2005 ;84:40-6.

Lukenbill J, Rybicki L, Sekeres MA, Zaman MO, Copelan A, Haddad H, Fraser T, DiGiorgio MJ, Hanna R, Duong H, Hill B, Kalaycio M, Sobecks R, Bolwell B, Copelan E. Defining incidence, risk factors, and impact on survival of central line-associated blood stream infections following hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant 2013; 19:720-4.

Shigematsu A, Yamamoto S, Sugita J, Kondo T, Onozawa M, Kahata K, Endo T, Shiratori S, Ota S, Yamaguchi K, Wakasa K, Takahata M, Goto H, Ito S, Takemura R, Tanaka J, Hashino S, Nishio M, Koike T, Asaka M, Imamura M. Increased risk of bacterial infection after engraftment in patients treated with allogeneic bone marrow transplantation following reduced-intensity conditioning regimen. Transpl Infect Dis 2010 ;12:412-20.

Liu CY, Lai YC, Huang LJ, Yang YW, Chen TL, Hsiao LT, Liu JH, Gau JP, Chen PM, Tzeng CH, Chiou TJ. Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients. Bone Marrow Transplant 2011 ;46:1231-9.

Busca A, Cavecchia I, Locatelli F, D'Ardia S, De Rosa FG, Marmont F, Ciccone G, Baldi I, Serra R, Gaido E, Falda M. Blood stream infections after allogeneic stem cell transplantation: a single-center experience with the use of levofloxacin prophylaxis. Transpl Infect Dis 2012 ;14:40-8.

Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet 2009; 373:1550-61.

El-Mahallawy H, Samir I, Abdel Fattah R, Kadry D, El-Kholy A. Source, pattern and antibiotic resistance of blood stream infections in hematopoietic stem cell transplant recipients. J Egypt Natl Canc Inst 2014; 26:73-7.

Therriault BL, Wilson JW, Barreto JN, Estes LL. Characterization of bacterial infections in allogeneic hematopoietic stem cell transplant recipients who received prophylactic levofloxacin with either penicillin or doxycycline. Mayo Clin Proc 2010; 85:711-8.

Oliveira AL, de Souza M, Carvalho-Dias VM, Ruiz MA, Silla L, Tanaka PY, Simões BP, Trabasso P, Seber A, Lotfi CJ, Zanichelli MA, Araujo VR, Godoy C, Maiolino A, Urakawa P, Cunha CA, de Souza CA, Pasquini R, Nucci M. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2007; 39:775-81.

Mikulska M, Del Bono V, Raiola AM, Bruno B, Gualandi F, Occhini D, di Grazia C, Frassoni F, Bacigalupo A, Viscoli C. Blood stream infections in allogeneic hematopoietic stem cell transplant recipients: reemergence of Gram-negative rods and increasing antibiotic resistance. Biol Blood Marrow Transplant 2009; 15:47-53.

Rupp ME, Fey PD. Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs 2003; 63:353-65.

Harada S, Ishii Y, Yamaguchi K. Extended-spectrum beta-lactamases: implications for the clinical laboratory and therapy. Korean J Lab Med 2008; 28:401-12.

Slade M, Fakhri B, Savani BN, Romee R. Halfway there: the past, present and future of haploidentical transplantation. Bone Marrow Transplant 2016; e-pub ahead of print Jul 25; doi: 10.1038/bmt.2016.190.

Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ, Cahn JY, Calderwood S, Gratwohl A, Socié G, Abecasis MM, Sobocinski KA, Zhang MJ, Horowitz MM. IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol 1997; 97:855-64.

Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers ME. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11:945-56.

Pagano L, Caira M, Nosari A, Van Lint MT, Candoni A, Offidani M, Aloisi T, Irrera G, Bonini A, Picardi M, Caramatti C, Invernizzi R, Mattei D, Melillo L, de Waure C, Reddiconto G, Fianchi L, Valentini CG, Girmenia C, Leone G, Aversa F. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study--Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis 2007; 45:1161-70.

Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48:452-8.

Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G, Allione B, D'Antonio D, Buelli M, Nosari AM, Cilloni D, Zuffa E, Cantaffa R, Specchia G, Amadori S, Fabbiano F, Deliliers GL, Lauria F, Foà R, Del Favero A; Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Infection Program. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005; 353:977-87.

Pohlen M, Marx J, Mellmann A, Becker K, Mesters RM, Mikesch JH, Schliemann C, Lenz G, Müller-Tidow C, Büchner T, Krug U, Stelljes M, Karch H, Peters G, Gerth HU, Görlich D, Berdel WE. Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: two parallel patient cohorts treated in a single center. Haematologica 2016; 101:1208-1215.

Orasch C, Weisser M, Mertz D, Conen A, Heim D, Christen S, Gratwohl A, Battegay M, Widmer A, Flückiger U. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2010; 45:521-6.

Taur Y, Xavier JB, Lipuma L, Ubeda C, Goldberg J, Gobourne A, Lee YJ, Dubin KA, Socci ND, Viale A, Perales MA, Jenq RR, van den Brink MR, Pamer EG. Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis 2012; 55:905-14.

Montassier E, Al-Ghalith GA, Ward T, Corvec S, Gastinne T, Potel G, Moreau P, de la Cochetiere MF, Batard E, Knights D. Pretreatment gut microbiome predicts chemotherapy-related bloodstream infection. Genome Med 2016; 8:49.

Abstract views:
125

Views:
PDF
37
HTML
28

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


Copyright (c) 2017 Mediterranean Journal of Hematology and Infectious Diseases

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

The Mediterranean Journal of Hematology and Infectious Diseases [eISSN 2035-3006] is owned by the U.C.S.C. and it is published by PAGEPress®, Pavia, Italy. All credits and honors to PKP for their OJS.
 
 
© PAGEPress 2008-2017     -     PAGEPress is a registered trademark property of PAGEPress srl, Italy.     -     VAT: IT02125780185