Risk factors for late Staphylococcus aureus bacteremia after allogeneic hematopoietic stem cell transplantation: A single-Institution, nested case-controlled study Journal Article
| Authors: | Mihu, C. N.; Schaub, J.; Kesh, S.; Jakubowski, A.; Sepkowitz, K.; Pamer, E. G.; Papanicolaou, G. A. |
| Article Title: | Risk factors for late Staphylococcus aureus bacteremia after allogeneic hematopoietic stem cell transplantation: A single-Institution, nested case-controlled study |
| Abstract: | We report on the incidence, risk factors, and outcome of late Staphylococcus aureus bacteremia (SAB) in a cohort of 709 adult and pediatric patients at Memorial Sloan-Kettering Cancer Center between September 1999 and December 2006. The SAB cases were identified by prospective surveillance and examination of a computerized database. Late SAB was defined as SAB occurring > 50 days post-hematopoietic stem cell transplantation (HSCT). A nested case-controlled study was conducted to identify predictors of late SAB. The incidence of late SAB was 6/100,000 patient-days. The median time from stem cell infusion to incident blood culture was 137 days (range, 55 to 581 days). Eighty-four percent of the cases were community acquired; 40% involved a focal infection. Bacteremia was persistent (>3 days) despite removal of endovascular access in > 50% of cases. Risk factors for late SAB were acute graft-versus-host disease (aGVHD) flare, acute or chronic skin GVHD (cGVHD), corticosteroid use, liver dysfunction, and prolonged hospital length of stay (LOS) post-HSCT. In multivariate models, skin GVHD (P = .002) and LOS (P = .02) remained significant. The median survival post-SAB was 135 days (range, 1 to 1765 days). Late SAB occurred mainly in the setting of GVHD or corticosteroid therapy. Clinical manifestations were highly variable. Multiple comorbidities, indicated by organ dysfunction and hospitalization, likely contributed to persistence and increased morbidity and mortality. We recommend a high index of suspicion and empiric antistaphylococcal treatment pending culture results in high-risk patients undergoing HSCT. © 2008 American Society for Blood and Marrow Transplantation. |
| Keywords: | adolescent; adult; cancer survival; child; controlled study; aged; child, preschool; disease-free survival; middle aged; survival rate; retrospective studies; transplantation, homologous; major clinical study; case control study; busulfan; fludarabine; mortality; liver dysfunction; united states; methotrexate; incidence; cohort analysis; risk factors; aciclovir; cyclophosphamide; melphalan; pneumocystis pneumonia; hematopoietic stem cell transplantation; chronic myeloid leukemia; prediction; risk factor; cancer mortality; thiotepa; acute lymphoblastic leukemia; high risk patient; time factors; chronic disease; length of stay; acute graft versus host disease; chronic graft versus host disease; hematologic malignancy; myelodysplastic syndrome; whole body radiation; hematologic neoplasms; infant; infant, newborn; lymphoma; comorbidity; acute myeloblastic leukemia; allogeneic hematopoietic stem cell transplantation; bacteremia; virus infection; staphylococcus aureus; methicillin resistant staphylococcus aureus; staphylococcal infections; vancomycin; corticosteroid; cyclosporin a; graft vs host disease; cotrimoxazole; disease exacerbation; fluconazole; pentamidine; mycosis; infection risk; acute disease; disease surveillance; blood culture; adrenal cortex hormones; case-controlled; late staphylococcus aureus bacteremia; vascular access |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 14 |
| Issue: | 12 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-12-01 |
| Start Page: | 1429 |
| End Page: | 1433 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2008.09.005 |
| PUBMED: | 19041067 |
| PROVIDER: | scopus |
| PMCID: | PMC6000823 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus" |
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283Pamer -
238Papanicolaou -
455Jakubowski -
1
Schaub
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