Infect Chemother.  2023 Jun;55(2):204-213. 10.3947/ic.2022.0146.

Post-engraftment Bloodstream Infections After Allogeneic Hematopoietic Cell Transplantation: Risk Factors and Association with Mortality

• Akhmedov M
• Klyasova G
• Kuzmina L
• Fedorova A
• Drokov M
• Parovichnikova E

• KMID: 2544439
• DOI: http://doi.org/10.3947/ic.2022.0146

Abstract

Background
Bloodstream infections (BSIs) are major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). This study aimed to analyze the incidence, etiology, risk factors and outcomes of post-engraftment BSI in allo-HCT recipients.
Materials and Methods
The retrospective study included 261 patients with documented engraftment after first alloHCT performed from January 2018 till September 2021.
Results
Of 261 patients 29 (11.1%) developed at least one post-engraftment BSIs episode with a median time to post-engraftment BSI of 49 days (range, 1 - 158 days from the engraftment). A total of 45 pathogens were isolated from blood – 64.4% (n = 29) were represented by Gram-negative bacteria, and 35.6% (n = 16) – by Gram-positive bacteria. Secondary graft failure (hazard ratio [HR]: 39.93; 95% confidence interval [CI]: 7.64-208.74; P <0.001), secondary poor graft function (HR: 18.07; 95% CI: 3.53 - 92.44; P <0.001), and acute gut graft-versus-host-disease (GvHD) grade II-IV (HR: 29.86; 95% CI: 10.53 - 84.68; P <0.001) were associated with the higher risk of Gram-negative post-engraftment BSIs. Overall 30-day survival after post-engraftment BSIs was 71.4%. By multivariate analysis postengraftment BSIs (HR: 3.09; 95% CI: 1.29 – 7.38; P = 0.011), and acute gut GvHD grade II-IV (HR: 6.60; 95% CI: 2.78 -15.68; P <0.001) were associated with the higher 180-day non-relapse mortality risk.
Conclusion
Gram-negative bacteria prevailed in the etiology of post-engraftment BSIs with secondary graft failure. secondary poor graft function. and acute gut GvHD being the main predisposing factors for their development. Postengraftment BSIs were associated with the higher risk of non-relapse mortality after allo-HCT.

Keyword

Allogeneic hematopoietic cell transplantation; Post-engraftment; Bloodstream infections; Risk factors; Mortality