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Post-Transplant Events

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

Bone Marrow Transplantation volume 40, pages 63–70 (2007)Cite this article

Abstract

Blood stream infection (BSI) is a serious complication of hematopoietic stem cell transplantation (HSCT). The aim of this retrospective cohort analysis was to describe BSI after HSCT, and to assess the predictors and outcomes of BSI after HSCT using multivariable modeling. Of the 243 subjects transplanted, 56% received allogeneic HSCT and 106 (43.6%) developed BSI. Of the 185 isolates, 68% were Gram-positive cocci, 21% were Gram-negative bacilli (GNR) and 11% were fungi. Type of allogeneic HSCT was an independent risk factor for BSI (hazard ratio (HR) 3.26, 95% confidence interval (CI) 1.50, 7.07, P=0.01), as was the degree of HLA matching (HR 1.84, 95% CI 1.00, 3.37, P=0.05). BSI was a significant independent predictor of mortality after HSCT (HR 1.79, 95% CI 1.18, 2.73, P=0.007), after adjusting for acute graft-versus-host disease (GVHD) and allogeneic HSCT (both predicting death ⩽3 months after HSCT). In contrast to the effects of acute GVHD and allogeneic HSCT, the effect of BSI was evident throughout the post-HSCT period. GNR BSI and vancomycin-resistant enterococcal BSI also were significantly associated with death. We concluded that BSI is a common complication of HSCT associated with increased mortality throughout the post-HSCT period.

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Acknowledgements

We thank Robin Ruthazer, MPH for her thoughtful comments on the statistical analysis and Dr Silvia Munoz-Price for her help with data extraction of the acute graft-versus-host data. These data were presented in part at the Infectious Disease Society of America Annual Meeting, 12–15 October 2006, Toronto, Canada. Dr Poutsiaka was supported in part by the National Center for Research Resources, National Institutes of Health K23RR020042-02.

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Authors and Affiliations

  1. Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA

    D D Poutsiaka & D R Snydman

  2. Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA

    L L Price

  3. Tufts University School of Medicine, Boston, MA, USA

    A Ucuzian

  4. Division of Hematology and Oncology, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA

    G W Chan & K B Miller

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  1. D D Poutsiaka
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Correspondence to D D Poutsiaka.

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Poutsiaka, D., Price, L., Ucuzian, A. et al. Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant 40, 63–70 (2007). https://doi.org/10.1038/sj.bmt.1705690

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