Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation
Healthcare Burden, Risk Factors, and Outcomes of Mucosal Barrier Injury Laboratory-Confirmed Bloodstream Infections after Stem Cell Transplantation
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DOI：
10.1016/j.bbmt.2016.06.002
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发表时间：
2016-09-01
影响因子：
4.3
通讯作者：
Davies, Stella M.
中科院分区：
文献类型：
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作者：
Dandoy, Christopher E.;Haslam, David;Davies, Stella M.
在造血干细胞移植(HSCT)患者中，黏膜屏障损伤实验室确认的血流感染(MBI-LCBI)会导致显著的发病率、死亡率和医疗资源利用。确定MBI-LCBI的医疗负担并确定有MBI-LCBI风险的患者将使研究人员能够确定降低MBI-LCBI发生率的策略。我们研究的目的是描述在造血干细胞移植患者中进行MBI-LCBI的发生率、危险因素、时机和结果。我们对374名在大型独立学术儿童医院接受HSCT的患者进行了回顾性分析，以确定HSCT后第一年发生血流感染(BSI)的发生率、危险因素和预后，包括MBI-LCBI、中心线相关性BSI(CLABSI)或继发性BSI。观察指标包括无复发死亡率(NRM)、培养阳性后7天内拔除中心静脉导管、休克、培养阳性后48小时内进入儿科重症监护病房(PICU)，以及培养阳性后10天内死亡。在100名患者(27%)中诊断出170例BSI：80例(47%)MBI-LCBIs，68例(40%)CLABSI，22例(13%)继发性感染。在异基因HSCT患者中，MBI-LCBI的诊断率显著更高(18%比7%，P=0.007)。低强度的调理(OR，1.96；P=.015)和移植相关的血栓性微血管病变(OR，2.94；P=.0004)与MBI-LCBI相关。所有患有BSI的患者中，近50%发生感染性休克，10%在培养阳性后10天内死亡，近25%被转移到PICU。HSCT后1年有1例(34%)和1例以上(56%)BSI患者的1年NRM显著高于未发生BSI的患者(14%)(P
Mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) lead to significant morbidity, mortality, and healthcare resource utilization in hematopoietic stem cell transplant (HSCT) patients. Determination of the healthcare burden of MBI-LCBIs and identification of patients at risk of MBI-LCBIs will allow researchers to identify strategies to reduce MBI-LCBI rates. The objective of our study was to describe the incidence, risk factors, timing, and outcomes of MBI-LCBIs in hematopoietic stem cell transplant patients. We performed a retrospective analysis of 374 patients who underwent HSCT at a large free-standing academic children's hospital to determine the incidence, risk factors, and outcomes of patients that developed a bloodstream infection (BSI) including MBI-LCBI, central line-associated BSI (CLABSI), or secondary BSI in the first year after HSCT. Outcome measures included nonrelapse mortality (NRM), central venous catheter removal within 7 days of positive culture, shock, admission to the pediatric intensive care unit (PICU) within 48 hours of positive culture, and death within 10 days of positive culture. One hundred seventy BSIs were diagnosed in 100 patients (27%): 80 (47%) MBI-LCBIs, 68 (40%) CLABSIs, and 22 (13%) secondary infections. MBI-LCBIs were diagnosed at a significantly higher rate in allogeneic HSCT patients (18% versus 7%, P = .007). Reduced-intensity conditioning (OR, 1.96; P = .015) and transplant-associated thrombotic microangiopathy (OR, 2.94; P = .0004) were associated with MBI-LCBI. Nearly 50% of all patients with a BSI developed septic shock, 10% died within 10 days of positive culture, and nearly 25% were transferred to the PICU. One-year NRM was significantly increased in patients with 1 (34%) and more than 1 (56%) BSIs in the first year post-HSCT compared with those who did not develop BSIs (14%) (P