Pneumonia in allogeneic stem cell transplantation recipients: a multicenter prospective study
Pneumonia in allogeneic stem cell transplantation recipients: a multicenter prospective study
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DOI：
10.1111/j.1399-0012.2011.01495.x
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发表时间：
2011-11-01
影响因子：
2.1
通讯作者：
Miguel Cisneros, Jose
中科院分区：
文献类型：
--
作者：
Aguilar-Guisado, Manuela;Jimenez-Jambrina, Margarita;Miguel Cisneros, Jose
肺炎是异基因造血干细胞移植（allo-HSCT）后死亡的常见原因，但更新和前瞻性信息是不完整的。这项全国性前瞻性研究的目的是确定异基因造血干细胞移植受者中肺炎的当前流行病学、病因和结果。从2003年9月到2005年11月，427名连续的allo-HSCT接受者中发生了112次发作（每100例allo-HSCT/年发生率52.2例），其中72例（64.3%）是微生物学定义的肺炎。细菌性肺炎（44.4%）比真菌性肺炎（29.2%）和病毒性肺炎（19.4%）更常见。每组中最常见的微生物为：大肠杆菌（n = 7，8.9%）、肺炎链球菌（n = 4，5.0%）、巨细胞病毒（n = 12，15.4%）和曲霉属。 （n = 12，15.4%）。肺炎和慢性移植物抗宿主病 (GVHD) 的发生与异基因 HSCT 后死亡率增加相关，并且至少发生过一次肺炎的患者的生存概率显着较低 (p < 0.01)。移植后前 100 天内发生肺炎、真菌病因、GVHD、急性呼吸衰竭和感染性休克与肺炎后死亡率增加相关。我们的结果表明，肺炎仍然是异基因造血干细胞移植后常见的感染并发症，导致显着的死亡率，并为这些患者的肺炎的发病率、病因和结果提供了大量的最新经验。
Pneumonia is a common cause of mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT) but updated and prospective information is partial. The aim of this nationwide prospective study is to determine the current epidemiology, etiology, and outcome of pneumonia in allo-HSCT recipients. From September-2003 to November-2005, 112 episodes in 427 consecutive allo-HSCT recipients were included (incidence 52.2 per 100 allo-HSCT/yr), and 72 of them (64.3%) were microbiologically defined pneumonia. Bacterial pneumonia (44.4%) was more frequent than fungal (29.2%) and viral pneumonia (19.4%). The most frequent microorganisms in each group were: Escherichia coli (n = 7, 8.9%), Streptococcus pneumoniae (n = 4, 5.0%), cytomegalovirus (n = 12, 15.4%), and Aspergillus spp. (n = 12, 15.4%). The development of pneumonia and chronic graft-versus-host disease (GVHD) was associated with increased mortality after allo-HSCT, and the probability of survival was significantly lower in patients that had at least one pneumonia episode (p < 0.01). Pneumonia development in the first 100 d after transplantation, fungal etiology, GVHD, acute respiratory failure, and septic shock were associated with increased mortality after pneumonia. Our results show that pneumonia remains a frequent infectious complication after allo-HSCT, contributing to significant mortality, and provide a large current experience with the incidence, etiology and outcome of pneumonia in these patients.