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Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia After Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey

2017; Oxford University Press; Volume: 65; Issue: 11 Linguagem: Inglês

10.1093/cid/cix690

1537-6591

Corrado Girmenia, Alice Bertaina, Alfonso Piciocchi, Katia Perruccio, Alessandra Algarotti, Alessandro Busca, Chiara Cattaneo, Anna Maria Raiola, Stefano Guidi, Anna Paola Iori, Anna Candoni, Giuseppe Irrera, Giuseppe Milone, G. Marcacci, Rosanna Scimè, Maurizio Musso, Laura Cudillo, Simona Sica, Luca Castagna, Paolo Corradini, Francesco Marchesi, Domenico Pastore, Emilio Paolo Alessandrino, C. Annaloro, Fabio Ciceri, Stella Santarone, Luca Nassi, Claudio Farina, Claudio Viscoli, Gian María Rossolini, Francesca Bonifazi, Alessandro Rambaldi, Saveria Capria, Alice Bertaina, Angela Mastronuzzi, Daria Pagliara, Paola Bernaschi, Lucia Amico, Alessandra Carotti, Antonella Mencacci, Alessandro Busca, Benedetto Bruno, Cristina Costa, Angela Passi, G Ravizzola, Emanuele Angelucci, Anna Marchese, Patrizia Pecile, Anna Candoni, Giovanna Ventura, Renato Fanin, Claudio Scarparo, Angelo Pasquale Barbaro, Giuseppe Milone, Salvatore Leotta, Anna Marchese, G. Marcacci, Cristina Becchimanzi, Daniela Donnarumma, Stefania Tringali, Maria Teresa Baldi, Renato Scalone, Maria Teresa Baldi, Laura Cudillo, Alessandra Picardi, William Arcese, Carla Fontana, Simona Sica, Sabrina Giammarco, Teresa Spanu, Luca Castagna, Roberto Crocchiolo, Erminia Casari, Paolo Corradini, Alberto Mussetti, Eutilia Conte, Fabrizio Ensoli, G. Miragliotta, P. Marone, Milena Arghittu, Raffaella Greco, Alessandra Forcina, Paola Chichero, Stella Santarone, Paolo Di Bartolomeo, Paolo Fazii, Vesselina Kroumova, Nunzia Decembrino, Marco Zecca, P. Marone, Giovanni Pisapia, Giulia Palazzo, Giulia Palazzo, Edoardo Lanino, Maura Faraci, Elio Castagnola, Roberto Bandettini, Rocco Pastano, Simona Sammassimo, Rita Passerini, Piero Maria Stefani, Filíppo Gherlinzoni, Roberto Rigoli, Lucia Prezioso, Benedetta Cambò, Adriana Calderaro, Angelo Michele Carella, Nicola Cascavilla, Maria Labonia, Ivana Celeghini, Nicola Mordini, Federica Piana, Adriana Vacca, Marco Sanna, Giovanni Podda, Maria Teresa Corsetti, Andrea Rocchetti, Daniela Cilloni, Marco De Gobbi, Ornella Bianco, Franca Fagioli, Francesca Carraro, Gianfranco De Intinis, Alessandro Severino, Anna Proia, Gabriella Parisi, Daniele Vallisa, Massimo Confalonieri, Domenico Russo, Michele Malagola, G Ravizzola, Piero Galieni, Sadia Falcioni, Valeria Travaglini, Roberto Raimondi, Carlo Borghero, Giacomina Pavan, Arcangelo Prete, Tamara Belotti, Simone Ambretti, Manuela Imola, Anna Maria Mianulli, Maria Federica Pedna, Simone Cesaro, Giuliana Lo Cascio, Antonella Ferrari, Monica Piedimonte, Iolanda Santino, Monica Calandrelli, Attilio Olivieri, Francesca Orecchioni, M Mirabile, Riccardo Centurioni, Luciana Gironacci, Daniela Caravelli, Susanna Gallo, Marco Filippi, Luca Cupelli, Teresa Dentamaro, Silvana Falco, Ospedale S Eugenio, Serena Marotta, Antonio M. Risitano, Dora Lula, Pellegrino Musto, Giuseppe Pietrantuono, Antonio Traficante, Elisabetta Cerchiara, Maria Cristina Tirindelli, Giordano Dicuonzo, Anna Chierichini, Barbara Anaclerico, P Placanica,

Mycobacterium research and diagnosis

Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable.We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant.The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P <.001) and auto-HSCT (2.43; 1.22-4.84; P = .01).Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB.NCT02088840.