Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients
Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients
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DOI：
10.1111/j.1399-3062.2005.00088.x
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发表时间：
2005-03-01
影响因子：
2.6
通讯作者：
Papanicolaou, GA
中科院分区：
文献类型：
--
作者：
Almyroudis, NG;Fuller, A;Papanicolaou, GA
我们报告了1999年9月至2003年6月在斯隆-凯特琳纪念医院接受造血干细胞移植(HSCT)的298名成人和儿童患者的血流感染(BSI)发生率、危险因素和预后。方法：研究方法。前瞻性监测研究。BSI率按每10,000天HSCT报告。植入日期被定义为在Stein细胞输注后至少连续3个中性粒细胞绝对计数的日期中的第一个。BSI严重程度等级：严重(静脉注射抗生素)、危及生命(败血症)或致命性(导致或促成死亡)。结果。植入前和植入后BSI的发生率分别为22%和19.5%，植入前最高的是绿色链球菌(58株)、肠杆菌科(39株)和粪肠球菌(34株)。植入率从0.2%到2.9%不等，无明显病原体。在多变量分析中，植入前的BSI与慢性粒细胞白血病的诊断、年龄和18岁及外周血干细胞移植相关；植入后的BSI与急性移植物抗宿主病、中性粒细胞减少症和肝或肾功能障碍相关。植入前和植入后的归属死亡率分别为12.5%和1.7%。BSI病死率为绿色链球菌24%、粪肠球菌8%、金黄色葡萄球菌11%、念珠菌67%。结论。植入前的BSI，特别是由绿色链球菌和粪肠球菌引起的BSI，与大量的归因性死亡率有关。植入后的BST是移植后并发症的标志，很少是主要的死亡原因。
We report on bloodstream infection (BSI) rates, risk factors, and outcome in a cohort of 298 adult and pediatric hematopoietic stein 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 engraftment is defined as the first of at least 3 consecutive dates of absolute neutrophil count > 500/mm(3) after stein 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 Staplylococcus aureus, and 67% for Candida. Conclusions. Pre-engraftment BSI, especially by viridans streptococci and E faecium, was associated with substantial attributable mortality Post-engraftment BST was a marker of post-transplant complications and rarely the primary cause of death.