Mycobacterial infections in adult recipients of allogeneic hematopoietic stem cell transplantation: A cohort study in a high endemic area
Mycobacterial infections in adult recipients of allogeneic hematopoietic stem cell transplantation: A cohort study in a high endemic area
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DOI：
10.1016/j.jmii.2018.07.001
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发表时间：
2020-04-01
影响因子：
7.4
通讯作者：
Liu, Jin-Hwang
中科院分区：
文献类型：
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作者：
Liu, Yao-Chung;Wu, Chi-Jung;Liu, Jin-Hwang
背景：分枝杆菌感染是器官移植后重要且可能危及生命的并发症。值得注意的是，对于异体造血干细胞移植（HSCT）的受者，有一些支持性的结果来探讨移植后的分枝杆菌感染。台湾是该病的高发地区。我们的目的是调查移植后分枝杆菌感染的发病率、危险因素和生存率，包括结核分枝杆菌（MTB）和非结核分枝杆菌（NTM）。方法：我们纳入了2003年1月至2014年12月在亚洲三级医疗中心接受同种异体造血干细胞移植的422名成年患者。共有26名受试者出现移植后分枝杆菌感染。收集和分析移植后分枝杆菌感染的危险因素、临床特征和生存率。结果：422例HSCT患者移植后发生分枝杆菌感染26例（6.2%）。MTB和NTM两年累计发病率分别为1.4%和5.4%。在多因素分析中，年龄在50岁至45岁之间（校正风险比2.21,95% CI 1.01-4.83）和广泛的慢性移植物抗宿主病（校正风险比4.95,95% CI 2.14-11.46）被确定为感染的独立危险因素。复发患者的危险因素有趋势（P = 0.088）。对于cGVHD患者，感染分枝杆菌与未感染分枝杆菌的移植后生存率差异有统计学意义（P = 0.036）。肺炎是导致死亡的主要原因（n = 11, 42.3%）。结论：分枝杆菌感染在高发地区值得注意。一旦确定了高危人群，就需要作出很大努力，针对预防、早期发现和治疗感染的新方法。版权所有：台湾省微生物学会爱思唯尔台湾有限责任公司出版。
Background: Mycobacterial infections are important and potentially life-threatening complications after organ transplantations. Notably, for the recipients of allogeneic hematopoietic stem cell transplantation (HSCT), there are a few supporting results to explore post-transplant mycobacterial infections. Taiwan is a high endemic area of the infection. We aim to investigate the incidence, risk factors, and survival of post-transplant mycobacterial infections, including mycobacterium tuberculosis (MTB) and non-tuberculous mycobacterium (NTM).Methods: We included 422 adult patients undergoing allogeneic HSCT at an Asian tertiary medical center between January 2003 and December 2014. A total 26 subjects developed post-transplant mycobacterial infections. Risk factors, clinical features, and survival for posttransplant mycobacterial infections were collected and analyzed.Results: Post-transplant mycobacterial infections occurred in 26 (6.2%) of 422 HSCT patients. Two-year cumulative incidences in MTB and NTM were 1.4% and 5.4%. In the multivariate analysis, being age >45 years (adjusted HR 2.21, 95% CI 1.01-4.83) and extensive chronic graft-versus-host disease (cGVHD) (adjusted HR 4.95, 95% CI 2.14-11.46) were identified as independent risk factors of infections. There was a trend as a risk factors in relapsed patients (P = 0.088). For patients with cGVHD, there was a significant difference of post-transplant survival between mycobacterial infections and none (P = 0.036). Pneumonia contributed most to mortality (n = 11, 42.3%).Conclusion: Mycobacterial infections are worth to note in a high endemic area. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection and treatment of infections. Copyright (C) 2018, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.