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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
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- Dandoy, Christopher E. (författare)
- Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplantat & Immune Deficiency, 3333 Burnet Ave, Cincinnati, OH 45229 USA.
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- 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.
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- 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.
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- Ardura, Monica I. (författare)
- Nationwide Childrens Hosp, Dept Pediat, Div Infect Dis, Columbus, OH USA.
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- Brown, Valerie (författare)
- Penn State Hershey Childrens Hosp, Dept Pediat, Div Pediat Oncol Hematol, Hershey, PA USA.;Coll Med, Hershey, PA USA.
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- 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.
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- Diaz, Miguel Angel (författare)
- Hosp Infantil Univ, Dept Hematol Oncol, Madrid, Spain.
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- Dvorak, Christopher (författare)
- Univ Calif San Francisco, Div Pediat Allergy Immunol & Bone Marrow Transpla, Benioff Childrens Hosp, San Francisco, CA 94143 USA.
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- Farhadfar, Nosha (författare)
- Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
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- Flagg, Aron (författare)
- Yale New Haven Med Ctr, Dept Pediat, Div Pediat Hematol Oncol, 20 York St, New Haven, CT 06504 USA.
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- Ganguly, Siddartha (författare)
- Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, MO USA.
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- Hale, Gregory A. (författare)
- Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
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- Hashmi, Shahrukh K. (författare)
- Mayo Clin, Dept Internal Med, Rochester, MN USA.;King Faisal Specialist Hosp & Res Ctr, Ctr Oncol, Riyadh, Saudi Arabia.
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- Hematti, Peiman (författare)
- Univ Wisconsin, Div Hematol Oncol Bone Marrow Transplantat, Dept Med, Madison, WI USA.
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- Martino, Rodrigo (författare)
- Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain.
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- Nishihori, Taiga (författare)
- H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
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- Nusrat, Roomi (författare)
- Rutgers Robert Wood Johnson Med Sch, Dept Med, New Brunswick, NJ USA.
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- Olsson, Richard (författare)
- Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
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- Rotz, Seth J. (författare)
- Cleveland Clin, Childrens Hosp, Dept Pediat Hematol Oncol & Blood & Marrow Transp, Cleveland, OH 44106 USA.
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- Sung, Anthony D. (författare)
- Duke Univ, Div Hematol Malignancies & Cellular Therapy, Dept Med, Sch Med, Durham, NC USA.
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- Perales, Miguel-Angel (författare)
- Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
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- 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.
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- Komanduri, Krishna V. (författare)
- Univ Miami, Dept Med, Miami, FL USA.
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- 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.
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 3:1
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://jamanetwork....
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- 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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Dandoy, Christop ...
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Kim, Soyoung
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Chen, Min
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Ahn, Kwang Woo
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Ardura, Monica I ...
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Brown, Valerie
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visa fler...
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Chhabra, Saurabh
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Diaz, Miguel Ang ...
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Dvorak, Christop ...
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Farhadfar, Nosha
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Flagg, Aron
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Ganguly, Siddart ...
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Hale, Gregory A.
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Hashmi, Shahrukh ...
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Hematti, Peiman
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Martino, Rodrigo
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Nishihori, Taiga
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Nusrat, Roomi
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Olsson, Richard
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Rotz, Seth J.
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Sung, Anthony D.
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Perales, Miguel- ...
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Lindemans, Carol ...
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Komanduri, Krish ...
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Riches, Marcie L ...
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Uppsala universitet
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Karolinska Institutet