Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients
| Autor: | Trudy N. Small, Dana Jaffe, Eric G. Pamer, A. Fuller, Genovefa A. Papanicolaou, Nikolaos G. Almyroudis, Ann A. Jakubowski, Kent A. Sepkowitz, Timothy E. Kiehn |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Hematopoietic stem cell transplantation Neutropenia Sepsis Risk Factors Internal medicine medicine Humans Transplantation Homologous Child Aged Cause of death Transplantation biology business.industry Hematopoietic Stem Cell Transplantation Infant Middle Aged bacterial infections and mycoses biology.organism_classification medicine.disease surgical procedures operative Infectious Diseases Viridans streptococci Child Preschool Immunology Absolute neutrophil count Female business human activities Enterococcus faecium |
| Zdroj: | Transplant Infectious Disease. 7:11-17 |
| ISSN: | 1399-3062 1398-2273 |
| DOI: | 10.1111/j.1399-3062.2005.00088.x |
| Popis: | We report on bloodstream infection (BSI) rates, risk factors, and outcome in a cohort of 298 adult and pediatric hematopoietic stem cell transplantation (HSCT) recipients at Memorial Sloan-Kettering Hospital from September 1999 through June 2003. Methods. Prospective surveillance study. BSI rates are reported per 10,000 HSCT days. Date of engraftment is defined as the first of at least 3 consecutive dates of absolute neutrophil count >500/mm(3) after stem cell infusion. BSI severity grades: severe (intravenous antibiotics), life threatening (sepsis), or fatal (caused or contributed to death). Results. The incidence of pre- and post-engraftment BSI was 22% and 19.5%, respectively. Pre-engraftment highest rates were observed for viridans streptococci (58), Enterobacteriaceae (39), and Enterococcus faecium (34). Post-engraftment rates ranged from 0.2 to 2.9 without any predominant pathogen. In multivariate analyses, pre-engraftment BSI was associated with diagnosis of chronic myelogenous leukemia, age >18 years and peripheral blood stem cell graft; post-engraftment BSI was associated with acute graft-versus-host disease, neutropenia, and liver or kidney dysfunction. Attributable mortality was 12.5% and 1.7% for pre- and post-engraftment BSI, respectively. BSI fatality rates were 24% for viridans streptococci, 8% for E. faecium, 11% for Staphylococcus aureus, and 67% for Candida. Conclusions. Pre-engraftment BSI, especially by viridans streptococci and E. faecium, was associated with substantial attributable mortality. Post-engraftment BSI was a marker of post-transplant complications and rarely the primary cause of death. |
| Databáze: | OpenAIRE |
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