Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon.

Autor: Moghnieh R; Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. moghniehrima@gmail.com.; Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon. moghniehrima@gmail.com., Tamim H; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon., Abyad A; Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon., Jadayel M; School of Pharmacy, Beirut Arab University, Beirut, Lebanon., Awad L; Pharmacy Department, Makassed General Hospital, Beirut, Lebanon., Abdallah D; Pharmacy Department, Makassed General Hospital, Beirut, Lebanon., Haddad N; Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA., Berberi J; Faculty of Medicine, Lebanese University, Beirut, Lebanon., Alwazir R; Faculty of Medicine, Lebanese University, Beirut, Lebanon., Taher R; Faculty of Medicine, Lebanese University, Beirut, Lebanon., Jisr T; Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon., Lakkis R; Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon., Zahran K; Division of Hematology/Oncology, Middle East Institute of Health, Bsalim, Lebanon., Ibrahim A; Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon.
Jazyk: angličtina
Zdroj: Infection [Infection] 2020 Jun; Vol. 48 (3), pp. 385-401. Date of Electronic Publication: 2020 Mar 13.
DOI: 10.1007/s15010-020-01407-6
Abstrakt: Background: Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital.
Methods: This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks.
Results: One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29-11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27-120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05-10.98), P = 0.04].
Conclusion: The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.
Databáze: MEDLINE