Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation
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- Ohta Takanori
- Department of Hematology, Kitakyushu Municipal Medical Center, Japan
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- Ueno Toshiyuki
- Department of Hematology, Kitakyushu Municipal Medical Center, Japan
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- Uehara Yasufumi
- Department of Hematology, Kitakyushu Municipal Medical Center, Japan
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- Yokoyama Takashi
- Department of Infectious Diseases, Kitakyushu Municipal Medical Center, Japan
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- Nakazawa Megumi
- Department of Infectious Diseases, Kitakyushu Municipal Medical Center, Japan
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- Sato Yoriko
- Department of Infectious Diseases, Kitakyushu Municipal Medical Center, Japan
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- Uchida Yujiro
- Department of Infectious Diseases, Kitakyushu Municipal Medical Center, Japan
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- Ohno Yuju
- Department of Hematology, Kitakyushu Municipal Medical Center, Japan
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- Sugio Yasuhiro
- Department of Hematology, Kitakyushu Municipal Medical Center, Japan
抄録
<p>Objective Infections after a second hematopoietic stem cell transplantation (HSCT) occur commonly and are associated with high mortality. However, studies on bloodstream infection (BSI) after a second HSCT are lacking. We therefore evaluated the details of BSI after a second HSCT. </p><p>Methods We retrospectively evaluated the incidence, etiology, risk factors, and outcomes of BSI after a second HSCT. </p><p>Patients Fifty-two adult patients with hematological malignancies who underwent allogeneic HSCT, including cord blood transplantation (CBT; n=33), as the second transplantation were enrolled. The second transplantation was limited to allogeneic HSCT. Patients who underwent HSCT for graft failure were excluded. </p><p>Results The median HSCT interval was 438 (range: 39-3,893) days. Overall, 31 (59.6%) patients received autologous HSCT as the first HSCT. The cumulative incidence of BSI was 40.4% at 100 days after the second HSCT, with Gram-positive bacteria accounting for the majority (30.8%) of pathogens. Overall, 92.0% of BSIs occurred during the pre-engraftment period, and Enterococcus faecium accounted for 29.6% of pathogens. On a multivariate analysis, CBT was most closely associated with pre-engraftment BSI after the second HSCT (hazard ratio: 3.43, 95% confidence interval: 1.05-11.23, p=0.042). The 1-year survival rate after the second HSCT was lower in patients with BSI than in patients without BSI (p=0.10). </p><p>Conclusion BSI is common after a second HSCT, especially with CBT. During the pre-engraftment period, BSI caused by pathogens such as E. faecium should be anticipated and appropriately treated to improve transplant outcomes. </p>
収録刊行物
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- Internal Medicine
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Internal Medicine 62 (22), 3305-3316, 2023-11-15
一般社団法人 日本内科学会