Bloodstream Infections in Adult Patients Undergoing Cord Blood Transplantation from Unrelated Donors after Myeloablative Conditioning Regimen
| Autor: | F. López, Eva María González-Barberá, Jheremy Reyes, Isabel Cano, Miguel A. Sanz, Ignacio Lorenzo, Pau Montesinos, Aima Lancharro, Federico Moscardó, Isidro Jarque, Jaime Sanz, Guillermo Sanz, Miguel Salavert, Jesús Martínez, Jose Luis López-Hontangas, Marcos Arango, María J. Arilla |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Transplantation Conditioning Adolescent Gastroenterology Internal medicine Epidemiology medicine Humans Cumulative incidence Risk factor Gram-Positive Bacterial Infections Retrospective Studies Umbilical cord blood transplantation Transplantation Nonrelapse mortality business.industry Umbilical Cord Blood Transplantation Incidence Mortality rate Incidence (epidemiology) Engraftment Hematology Middle Aged Allografts Confidence interval Surgery Hematologic Neoplasms Relative risk Female Cord Blood Stem Cell Transplantation Bloodstream infections Gram-Negative Bacterial Infections Unrelated Donors business |
| Zdroj: | Biology of Blood and Marrow Transplantation. 21:755-760 |
| ISSN: | 1083-8791 |
| DOI: | 10.1016/j.bbmt.2014.12.038 |
| Popis: | The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day –7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P = .04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR, .6; 95% CI, .5 to .9; P = .002). A higher CD8+ cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR, .1; 95% CI, .02 to .7; P = .02). The gram-negative rod (GNR) to gram-positive bacteria ratio was .9 before day +30 and 1.6 thereafter (P = .03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P = .03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period. |
| Databáze: | OpenAIRE |
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