Post-engraftment Bloodstream Infections After Allogeneic Hematopoietic Cell Transplantation: Risk Factors and Association with Mortality

Akhmedov Mobil; Klyasova Galina; Kuzmina Larisa; Fedorova Anastasia; Drokov Mikhail; Parovichnikova Elena

doi:10.3947/ic.2022.0146

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자료유형: 학술저널

저자정보: Akhmedov Mobil (National Research Center for Hematology Moscow Russia.) Klyasova Galina (National Research Center for Hematology Moscow Russia.) Kuzmina Larisa (National Research Center for Hematology Moscow Russia.) Fedorova Anastasia (National Research Center for Hematology Moscow Russia.) Drokov Mikhail (National Research Center for Hematology Moscow Russia.) Parovichnikova Elena (National Research Center for Hematology Moscow Russia.)

저널정보: 대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제55권 제2호

발행연도: 2023.6

수록면: 204 - 213 (10page)

DOI: 10.3947/ic.2022.0146

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Background Bloodstream infections (BSIs) are major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). This study aimed to analyze the incidence, etiology, risk factors and outcomes of post-engraftment BSI in allo-HCT recipients. Materials and Methods The retrospective study included 261 patients with documented engraftment after first allo-HCT performed from January 2018 till September 2021. Results Of 261 patients 29 (11.1%) developed at least one post-engraftment BSIs episode with a median time to post-engraftment BSI of 49 days (range, 1 - 158 days from the engraftment). A total of 45 pathogens were isolated from blood – 64.4% (n = 29) were represented by Gram-negative bacteria, and 35.6% (n = 16) – by Gram-positive bacteria. Secondary graft failure (hazard ratio [HR]: 39.93; 95% confidence interval [CI]: 7.64-208.74; P <0.001), secondary poor graft function (HR: 18.07; 95% CI: 3.53 - 92.44; P <0.001), and acute gut graft-versus-host-disease (GvHD) grade II-IV (HR: 29.86; 95% CI: 10.53 - 84.68; P <0.001) were associated with the higher risk of Gram-negative post-engraftment BSIs. Overall 30-day survival after post-engraftment BSIs was 71.4%. By multivariate analysis post-engraftment BSIs (HR: 3.09; 95% CI: 1.29 – 7.38; P = 0.011), and acute gut GvHD grade II-IV (HR: 6.60; 95% CI: 2.78 - 15.68; P <0.001) were associated with the higher 180-day non-relapse mortality risk. Conclusion Gram-negative bacteria prevailed in the etiology of post-engraftment BSIs with secondary graft failure. secondary poor graft function. and acute gut GvHD being the main predisposing factors for their development. Post-engraftment BSIs were associated with the higher risk of non-relapse mortality after allo-HCT.

#Allogeneic hematopoietic cell transplantation #Post-engraftment #Bloodstream infections #Risk factors #Mortality

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