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Sökning: onr:"swepub:oai:DiVA.org:uu-434444" > Incidence, Risk Fac...

Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant

Dandoy, Christopher E. (författare)
Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplantat & Immune Deficiency, 3333 Burnet Ave, Cincinnati, OH 45229 USA.
Kim, Soyoung (författare)
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Div Biostat, Inst Hlth & Equ, Milwaukee, WI 53226 USA.
Chen, Min (författare)
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.
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Ahn, Kwang Woo (författare)
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Div Biostat, Inst Hlth & Equ, Milwaukee, WI 53226 USA.
Ardura, Monica I. (författare)
Nationwide Childrens Hosp, Dept Pediat, Div Infect Dis, Columbus, OH USA.
Brown, Valerie (författare)
Penn State Hershey Childrens Hosp, Dept Pediat, Div Pediat Oncol Hematol, Hershey, PA USA.;Coll Med, Hershey, PA USA.
Chhabra, Saurabh (författare)
Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, Div Hematol Oncol, Milwaukee, WI 53226 USA.
Diaz, Miguel Angel (författare)
Hosp Infantil Univ, Dept Hematol Oncol, Madrid, Spain.
Dvorak, Christopher (författare)
Univ Calif San Francisco, Div Pediat Allergy Immunol & Bone Marrow Transpla, Benioff Childrens Hosp, San Francisco, CA 94143 USA.
Farhadfar, Nosha (författare)
Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
Flagg, Aron (författare)
Yale New Haven Med Ctr, Dept Pediat, Div Pediat Hematol Oncol, 20 York St, New Haven, CT 06504 USA.
Ganguly, Siddartha (författare)
Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, MO USA.
Hale, Gregory A. (författare)
Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
Hashmi, Shahrukh K. (författare)
Mayo Clin, Dept Internal Med, Rochester, MN USA.;King Faisal Specialist Hosp & Res Ctr, Ctr Oncol, Riyadh, Saudi Arabia.
Hematti, Peiman (författare)
Univ Wisconsin, Div Hematol Oncol Bone Marrow Transplantat, Dept Med, Madison, WI USA.
Martino, Rodrigo (författare)
Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain.
Nishihori, Taiga (författare)
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
Nusrat, Roomi (författare)
Rutgers Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ USA.
Olsson, Richard (författare)
Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
Rotz, Seth J. (författare)
Cleveland Clin, Childrens Hosp, Dept Pediat Hematol Oncol & Blood & Marrow Transp, Cleveland, OH 44106 USA.
Sung, Anthony D. (författare)
Duke Univ, Div Hematol Malignancies & Cellular Therapy, Dept Med, Sch Med, Durham, NC USA.
Perales, Miguel-Angel (författare)
Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
Lindemans, Caroline A. (författare)
Univ Utrecht, Univ Med Ctr Utrecht, Pediat Blood & Marrow Transplantat Program, Utrecht, Netherlands.;Princess Maxima Ctr Pediat Oncol, Dept Pediat, Div Pediat Stem Cell Transplantat, Utrecht, Netherlands.
Komanduri, Krishna V. (författare)
Univ Miami, Dept Med, Miami, FL USA.
Riches, Marcie L. (författare)
Univ N Carolina, Div Hematol Oncol, Chapel Hill, NC 27515 USA.
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Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplantat & Immune Deficiency, 3333 Burnet Ave, Cincinnati, OH 45229 USA Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Div Biostat, Inst Hlth & Equ, Milwaukee, WI 53226 USA. (creator_code:org_t)
2020-01-08
2020
Engelska.
Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 3:1
Relaterad länk:
https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://doi.org/10.1...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  •  Importance: Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other).Objective: To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT.Design, Setting, and Participants: A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8.8%]), MBI-LCBI and BSI-other (698 [4.1%]), BSI-other only (2928 [17.4%]), and controls with no BSI (11768 [69.7%]). Statistical analysis was performed from April 5 to July 17, 2018.Main Outcomes and Measures: Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups.Results: Of the 16875 patients in the study (9737 [57.7%] male; median [range] age, 47 [0.04-82] years) 13686 (81.1%) underwent HSCT for a malignant neoplasm, and 3189 (18.9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]).Conclusions and Relevance: In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population. This cohort study examines the incidence, timing, risk factors, and outcomes of patients who develop mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI) in the first 100 days after hematopoietic stem cell transplant (HSCT).

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Hematologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Hematology (hsv//eng)

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