| Resum: |
Importance: Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other). Objective: To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT. Design, Setting, and Participants: A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8. 8%]), MBI-LCBI and BSI-other (698 [4. 1%]), BSI-other only (2928 [17. 4%]), and controls with no BSI (11768 [69. 7%]). Statistical analysis was performed from April 5 to July 17, 2018. Main Outcomes and Measures: Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups. Results: Of the 16875 patients in the study (9737 [57. 7%] male; median [range] age, 47 [0. 04-82] years) 13686 (81. 1%) underwent HSCT for a malignant neoplasm, and 3189 (18. 9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1. 21 [99% CI, 1. 04-1. 41]), cord blood grafts (HR, 2. 89 [99% CI, 1. 97-4. 24]), myeloablative conditioning (HR, 1. 46 [99% CI, 1. 19-1. 78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1. 85 [99% CI, 1. 38-2. 48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1. 81 [99% CI, 1. 56-2. 12]), BSI-other (HR, 1. 81 [99% CI, 1. 60-2. 06]), and MBI-LCBI plus BSI-other (HR, 2. 65 [99% CI, 2. 17-3. 24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18. 8%]), BSI (251 of 1537 [16. 3%]), and MBI-LCBI plus BSI (94 of 435 [21. 6%]) than for controls (566 of 4740 [11. 9%]). Conclusions and Relevance: In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population. |
visitant ::
identificació
(Medical College of Wisconsin)
