Pre-engraftment bacteremia after allogeneic hematopoietic cell transplantation without primary fluoroquinolone antibacterial prophylaxis.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2024-09-23 DOI:10.1111/tid.14375

Aude Nguyen, Jordan Fender, Johan Courjon, Adrien Fischer, Maria Mappoura, Sarah Morin, Federica Giannotti, Anne-Claire Mamez, Yves Chalandon, Stavroula Masouridi-Levrat, Dionysios Neofytos

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Abstract

Background: Bacteremia is a common complication in allogeneic hematopoietic cell transplant recipients (alloHCTr), especially during the pre-engraftment period. International guidelines recommend antibacterial prophylaxis (ABP), despite potential selection for multidrug-resistant organisms (MDRO). Limited contemporary data exist on the epidemiology of pre-engraftment bacteremia in alloHCTr, who do not receive ABP.

Methods: We performed a retrospective observational single-center cohort study including all consecutive adult alloHCTr (2015-2021), investigating the incidence, risk factors, and outcomes of bacteremia during the engraftment period. Primary fluoroquinolone (FQ) ABP is not routinely administered in our center.

Results: Among 421 patients identified, 124 bacteremia episodes were observed in 121/421 (29%) alloHCTr. The median time to the 1st bacteremia episode was 9 days (IQR 6-11). Most (105/124, 85%) episodes were monomicrobial, while >1 pathogens were identified in 19/124 (15%) episodes. Overall, 152 pathogens were isolated, with a predominance of Gram-positive (118/152, 78%), including coagulase-negative staphylococci (n:47), streptococci (n:46), and enterococci (n:15), followed by Gram-negative bacteria (GNB, 30/152, 20%), and anaerobes (4/152, 3%). There were 2/152 (1%) MDRO (extended-spectrum beta-lactamase producing) GNB. Multivariable analyses identified age >40-year-old (OR 2.4, P = 0.02), male gender (OR 1.8, P = 0.02), and a haploidentical/mismatched unrelated donor (OR 2.5, P < 0.001) as independent risk factors for bacteremia. All cause 30-day mortality among alloHCTr with bacteremia was 0.8% (1/121): one patient died due to an HCT-related complication.

Conclusion: Despite lack of primary FQ ABP, low rates of bacteremia were observed during the pre-engraftment period, with low MDRO prevalence and mortality. Our findings may allow to revisit the need for primary universal FQ ABP in high-risk neutropenic hematology patients.

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同种异体造血细胞移植后移植前菌血症，未进行氟喹诺酮类抗菌药物一级预防。

背景：菌血症是异基因造血细胞移植受者（alloHCTr）的常见并发症，尤其是在移植前期。尽管可能会选择耐多药生物（MDRO），但国际指南仍建议进行抗菌预防（ABP）。有关未接受 ABP 的异体肝移植患者移植前菌血症流行病学的当代数据十分有限：我们进行了一项回顾性观察性单中心队列研究，包括所有连续的成人异体肝移植患者（2015-2021 年），调查移植期间菌血症的发生率、风险因素和结果。我们中心不常规使用初级氟喹诺酮（FQ）ABP：结果：在已确认的421例患者中，121/421例（29%）异体HCTr患者发生了124次菌血症，第一次菌血症发生的中位时间为9天（IQR 6-11）。大多数病例（105/124，85%）为单菌血症，而在 19/124（15%）病例中发现了超过 1 种病原体。总共分离出 152 种病原体，其中以革兰阳性菌为主（118/152，78%），包括凝固酶阴性葡萄球菌（47）、链球菌（46）和肠球菌（15），其次是革兰阴性菌（GNB，30/152，20%）和厌氧菌（4/152，3%）。2/152（1%）为 MDRO（产生广谱β-内酰胺酶）革兰氏阴性菌。多变量分析发现，年龄大于 40 岁（OR 2.4，P = 0.02）、男性（OR 1.8，P = 0.02）和单倍体/不匹配非亲属供体（OR 2.5，P < 0.001）是导致菌血症的独立风险因素。伴有菌血症的异体肝移植患者30天内的全因死亡率为0.8%（1/121）：一名患者死于与HCT相关的并发症：结论：尽管缺乏初级 FQ ABP，但在移植前期间观察到的菌血症发生率较低，MDRO 感染率和死亡率也较低。我们的研究结果可能会让我们重新审视在高风险中性粒细胞减少血液病患者中普及初级 FQ ABP 的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.