Bloodstream Infections in Adult Patients Undergoing Cord Blood Transplantation from Unrelated Donors after Myeloablative Conditioning Regimen

Autores de IIS La Fe

• Jaime Sanz Caballer

  Autor

• Isabel Cano Ferri

  Autor

• Eva María González Barberá

  Autor

• Javier Reyes Balaguer

  Autor

• Pau Montesinos Fernández

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• Isidro Jarque Ramos

  Autor

• Jesus Antonio Martinez Dominguez

  Autor

• Francisca Lopez Chulia

  Autor

• María Jesus Arilla Morell

  Autor

• Alma Lancharro

  Autor

• Federico Moscardo Garcia

  Autor

• José Luis López Hontangas

  Autor

• Miguel Salavert Lletí

  Autor

• Miguel Ángel Sanz Alonso

  Autor

• Guillermo Sanz Santillana

  Autor

Participantes ajenos a IIS La Fe

• Arango M

Grupos

• Alergia y enfermedades respiratorias de la Infancia

• Hematología y Hemoterapia

• Infección Grave

Abstract

The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day 7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P =.04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR,.6; 95% CI,.5 to.9; P =.002). A higher CD8+ cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR,.1; 95% Cl,.02 to.7; P =.02). The gram-negative rod (GNR) to gram-positive bacteria ratio was.9 before day +30 and 1.6 thereafter (P =.03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P =.03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period. (C) 2015 American Society for Blood and Marrow Transplantation.

Keywords

• Bloodstream infections; Umbilical cord blood transplantation; Engraftment; Nonrelapse mortality