Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients Journal Article

  


Authors: Almyroudis, N. G. ; Fuller, A.; Jakubowski, A.; Sepkowitz, K.; Jaffe, D.; Small, T. N.; Kiehn, T. E.; Pamer, E.; Papanicolaou, G. A.
Article Title: Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients
Abstract: 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 engraf tment 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. Copyright © Blackwell Munksgaard 2005.
Keywords: adolescent; adult; child; aged; child, preschool; middle aged; transplantation, homologous; major clinical study; mortality; neutropenia; liver dysfunction; disease association; infection; differential diagnosis; risk factors; health survey; stem cell transplantation; hematopoietic stem cell transplantation; chronic myeloid leukemia; risk factor; febrile neutropenia; hospitalization; acute graft versus host disease; neutrophil; infant; peripheral blood stem cell; sepsis; allogeneic hematopoietic stem cell transplantation; bloodstream infection; vancomycin; blood flow; cotrimoxazole; fluconazole; pentamidine; piperacillin plus tazobactam; enterococcus faecium; cefepime; kidney dysfunction; timentin; rates; amikacin; enterobacteriaceae; alpha hemolytic streptococcus
Journal Title: Transplant Infectious Disease
Volume: 7
Issue: 1
ISSN: 1398-2273
Publisher: Wiley Blackwell  
Date Published: 2005-03-01
Start Page: 11
End Page: 17
Language: English
DOI: 10.1111/j.1399-3062.2005.00088.x
PUBMED: 15984943
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-22144456755&partnerID=40&md5=ca1903956c57c93d7eabea965372fd0a
Notes: --- - "Cited By (since 1996): 25" - "Export Date: 24 October 2012" - "CODEN: TIDSF" - "Source: Scopus"
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MSK Authors
  1. Dana Jaffe
    13 Jaffe
  2. Nikolaos Almyroudis
    5 Almyroudis
  3. Trudy Small
    234 Small
  4. Kent A Sepkowitz
    272 Sepkowitz
  5. Eric Pamer
    283 Pamer
  6. Genovefa A Papanicolaou
    238 Papanicolaou
  7. Ann Jakubowski
    455 Jakubowski
  8. Timothy E Kiehn
    100 Kiehn
  9. Alexander E Fuller
    2 Fuller
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