Vancomycin Resistant Enterococcus (VRE) Bloodstream Infections (BSI) in Patients with Hematological Malignancies: Is the Sick Getting Sicker?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5373-5373
Author(s):  
Erik R. Dubberke ◽  
James Holland ◽  
Peter Georgantopolis ◽  
Kristan Augustin ◽  
John F. Dipersio ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Medical Condition ◽  
Chronic Gvhd ◽  
Univariate Analysis ◽  
Bloodstream Infections ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Anti Fungal

Abstract Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial BSI. Data describing the prognosis and outcomes of VRE BSI in this patient population is limited. We performed a retrospective chart review of all cases of VRE BSI occurring between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. 68 episodes of VRE BSI were observed in 60 patients with acute (53%) or chronic (8%) leukemia, NHL (22%), or other malignant hematologic disorders (17%).46 were autologous (13%), related (32%) and URD (32%) transplant recipients. Forty days prior to the VRE BSI, 70% were colonized with VRE, 95% had broad-spectrum antibiotic exposure and 42% had non-VRE BSI, 35% pneumonia, 22% CMV reactivation, 10% fungal infection. At the time of the VRE BSI, 42% of allograft recipients had active acute GVHD and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy, and 60% had end organ dysfunction with a median APACHE II score of 17. VRE was easily eradicated from the bloodstream after initiation of anti-VRE therapy (median time to clearance 1 (range 1–9) day). 3 patients died within 48 hours of the VRE BSI from causes unrelated to the BSI. Median survival after VRE BSI was 19 days. Only 4 deaths were directly attributable to the VRE BSI. Age, ECOG PS ≥ 2 on admission, HSCT, pneumonia, mechanical ventilation, acute neurologic dysfunction, receipt of anti-fungal drugs, and low APACHE II score were significant factors associated with death by univariate analysis, while pneumonia, receipt of anti-fungal drugs, and low APACHE II score at the time of the VRE BSI remained significant after multivariate analysis. In summary, our analysis suggests that in patients with hematological malignancies, VRE does not have the microbiologic behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients’s already existing critical medical condition.

scholarly journals Longitudinal Tear Protein Changes Correlate with Ocular Chronic GVHD Development in Allogeneic Hematopoietic Stem Cell Transplant Patients

2021 ◽  
Vol 11 (17) ◽  
pp. 8221
Author(s):  
Carmen Ciavarella ◽  
Gloria Astolfi ◽  
Nicola Valsecchi ◽  
Francesco Barbato ◽  
Mario Arpinati ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Chronic Gvhd ◽  
Univariate Analysis ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Tear Protein ◽  
Conditioning Treatment

Ocular graft-versus-host disease (oGVHD) is a manifestation of chronic GVHD, frequently occurring in patients after allogeneic hematopoietic stem cell transplant (HSCT). We analyzed tear protein changes before and after allogeneic HSCT, and correlated their levels with the oGVHD development. This retrospective study included 102 patients, and data were recorded before the conditioning treatment, and after 3 to 6 months postoperatively. Tear protein analysis was performed with the Agilent-2100 Bioanalyzer on individual tears sampled by aspiration. Total protein (TP), Lysozyme-C (LYS-C), Lactoferrin (LACTO), Lipocalin-1 (LIPOC-1), Transferrin (TRANSF), Albumin (ALB), and Zinc-alpha-2-glycoprotein (ZAG-2) levels were retrieved and statistically analyzed. Following HSCT forty-three patients developed oGVHD. TP, LACTO, LYS-C, and ZAG-2 levels significantly decreased post-HSCT as compared to pre HSCT levels. In univariate analysis, TP, LACTO, and ZAG-2 decrease was associated with an increased development of oGVHD (OR = 4.49; 95% CI, 1.9 to 10.5; p < 0.001; OR = 3.08; 95% CI 1.3 to 7.6; p = 0.01; OR = 11.1; 95% CI 2.7 to 46.6; p < 0.001, respectively). TRANSF post-HSCT levels significantly increased (OR 15.7; 95% CI, 4.1 to 52.2; p = 0.0001). No pre-post-HSCT changes were shown in ALB and LIPOC-1 levels. Data suggest that TP content, LACTO, TRANSF, and ZAG-2 pre-post changes might be significant predictors of oGVHD development.

scholarly journals The characteristics and outcomes of parainfluenza virus infections in 200 patients with leukemia or recipients of hematopoietic stem cell transplantation

Blood ◽  
2012 ◽  
Vol 119 (12) ◽  
pp. 2738-2745 ◽  
Author(s):  
Roy F. Chemaly ◽  
Santosh S. Hanmod ◽  
Dhanesh B. Rathod ◽  
Shashank S. Ghantoji ◽  
Ying Jiang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
Mortality Rate ◽  
Hematopoietic Stem Cell ◽  
Apache Ii ◽  
Parainfluenza Virus ◽  
Apache Ii Score ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Significant Difference

AbstractCommunity respiratory viruses are significant causes of morbidity and mortality in patients with leukemia and hematopoietic stem cell transplant (HSCT) recipients. Data on characteristics and outcomes of parainfluenza virus (PIV) infections in these patients are limited. We reviewed the records of patients with leukemia and HSCT recipients who developed PIV infections to determine the characteristics and outcomes of such infections. We identified 200 patients with PIV infections, including 80 (40%) patients with leukemia and 120 (60%) recipients of HSCT. At presentation, most patients (70%) had an upper respiratory tract infection and the remaining patients (30%) had pneumonia. Neutropenia, APACHE II score more than 15, and respiratory coinfections were independent predictors of progression to pneumonia on multivariate analysis. Overall mortality rate was 9% at 30 days after diagnosis and 17% among patients who had PIV pneumonia, with no significant difference between patients with leukemia and HSCT recipients (16% vs 17%). On multivariate analysis, independent predictors of death were relapsed or refractory underlying malignancy, APACHE II score more than 15, and high-dose steroid use. Patients with leukemia and HSCT are at risk for serious PIV infections, including PIV pneumonia, with a significant mortality rate. We identified multiple risk factors for progression to pneumonia and death.

scholarly journals The impact of procalcitonin to C-reactive protein ratio (PCR) kinetics as a predictor of mortality in nosocomial bloodstream infections

2020 ◽  
Author(s):  
Ismail Necati Hakyemez ◽  
Turan Aslan ◽  
Bulent Durdu
Keyword(s):  
Logistic Regression ◽  
Univariate Analysis ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Apache Ii ◽  
Apache Ii Score ◽  
C Reactive Protein ◽  
Protein Ratio ◽  
Reactive Protein ◽  
The Impact

Abstract Purpose: To investigate the combination of serum C-reactive protein (CRP) and procalcitonin (PCT) kinetics in predicting mortality in nosocomial blood stream infections (BSIs).Materials and Methods: We retrospectively reviewed the medical records of patients ≥ 18 years of age with nosocomial BSIs hospitalized in intensive care units (ICU). Clinical, microbiological and biochemical data were compared in patients who survivors and deaths. Binary logistic regression analyses were used to identify independent risk factors. The kinetic changes were defined the as difference between level on 5th day and level at 1st day of BSI.Results: Of the 84 included patients, 49 (58.4%) had survivors and 35 (41.6%) had deaths. In univariate analysis, renal disease (p=0.007), cardiac disease (p=0.042), septic shock (p=<0.001), SOFA (p=<0.001) and APACHE-II (p <0.001), ΔCRP (p=0.004), ΔPCT (p=<0.001), and ΔPCR (p=0.025) were significantly higher in non-survivors. In the logistic regression analysis, APACHE-II score (OR=1.46, 95% CI=1.20-1.78, p <0.001), ΔCRP (OR=1.18, %95 CI =1.04-1.34, p=0.009), ΔPCT (OR=0.87, 95% CI=0.79-0.95, p=0.001), and ∆PCR (OR=36.78, 95%C = 4.52-299.01, p=0.001) were independent predictors of 28-day mortality.Conclusions: The ∆PCR kinetic was a strong independent predictor of mortality in nosocomial BSIs in ICUs.

Outcomes of hematopoietic stem cell transplant recipients admitted to the medical intensive care unit.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7035-7035
Author(s):  
Duc Quang Tran ◽  
Amelia A. Langston ◽  
Edmund K. Waller ◽  
Melanie Simon ◽  
Charise Gleason ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Stem Cell ◽  
Intensive Care ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Predictors Of Mortality

7035 Background: Outcome results for hematopoietic stem cell transplant (HSCT) patients admitted to intensive care unit (ICU) and prognosis is infrequently reported during recent years, especially in view of increasing use of unrelated donors, increasing use of transplant maneuver in older patients using reduced intensity conditioning regimens and improvement in supportive care. We assessed our institutional survival outcomes and evaluated predictors of mortality in HSCT recipients admitted to ICU. Methods: Among the 390 HSCTs performed from March 2011 until July 2012, we retrospectively evaluated 34 HSCT patients admitted to ICU. 22 patients received mechanical ventilation (MV) or vasopressor support and were analyzed separately. All previously defined predictors of mortality were evaluated. SPSS version 20 was used for statistical analysis. Results: 9% of all HSCT patients were admitted to ICU. 65% of patients received allogeneic transplants. Major underlying hematological malignancies were AML/MDS (29%) and myeloma (24%). 41% were admitted for respiratory failure and 23.5% for sepsis. Median age was 55.5 (range: 27-76). Median length of ICU stay was 7 days (0-42) and median APACHE II score was 20 (9-39). 30 day and 60 day mortality rates are 47% and 62% among all patients; 54% and 68% among MV patients or receiving vasopressors. Predictors for day 30 mortality on univariate analysis among all patients were APACHE II score ≥26 (p=0.05). Predictors for day 60 mortality were APACHE II score ≥31 (p=0.001) and multiorgan failure (p=0.009). Among patients receiving MV or vasopressors, APACHE II score ≥31 is the only significant predictor of mortality (p=0.011). On multivariate analysis, APACHE II score ≥31 at day 30 hazards ratio (HR) 3.777 (95%CI 1.041-13.69; p=0.043) and at day 60 HR 3.789 (95%CI 1.07-13.45; p=0.039) are significant predictors of mortality. Conclusions: Significant predictors identified on multivariate analyses were APACHE II score ≥31 at day 30 and day 60. Interestingly, type of transplant is not a significant predictor of mortality. Future studies with larger patient samples and longer follow up are required for further understanding of prognosis in these patients.

scholarly journals Breakthrough Mucormycosis Developing on Mucorales-Active Antifungals Portrays a Poor Prognosis in Patients with Hematologic Cancer

2021 ◽  
Vol 7 (3) ◽  
pp. 217
Author(s):  
Dierdre B. Axell-House ◽  
Sebastian Wurster ◽  
Ying Jiang ◽  
Andreas Kyvernitakis ◽  
Russell E. Lewis ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Symptom Onset ◽  
Poor Prognosis ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Severe Neutropenia ◽  
Apache Ii Score ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Cox Regression Analysis

Although breakthrough mucormycosis (BT-MCR) is known to develop on mold-active antifungals without Mucorales activity, it can also occur while on Mucorales-active antifungals. Herein, we retrospectively compared the characteristics and outcomes of patients with hematologic malignancies (HMs) or hematopoietic stem cell transplant (HSCT) who developed BT-MCR on mold-active antifungals with or without Mucorales activity. Of the patients developing BT-MCR, 16 were on Mucorales-active antifungals (9 isavuconazole, 6 posaconazole, 1 amphotericin B), and 87 were on other mold-active agents (52 voriconazole, 22 echinocandins, 8 itraconazole, 5 echinocandin + voriconazole). Both groups were largely comparable in clinical characteristics. Patients developing BT-MCR while on Mucorales-active antifungals had higher 42-day mortality, from either symptom onset (63% versus 25%, p = 0.006) or treatment initiation (69% versus 39%, p = 0.028). In multivariate Cox regression analysis, exposure to Mucorales-active antifungals prior to BT-MCR had a hazard ratio of 2.40 (p = 0.015) for 42-day mortality from treatment initiation and 4.63 (p < 0.001) for 42-day mortality from symptom onset. Intensive care unit (ICU) admission and APACHE II score at diagnosis, non-recovered severe neutropenia, active HM, and amphotericin B/caspofungin combination treatment were additional independent predictors of 42-day mortality. In summary, BT-MCR on Mucorales-active antifungals portrays poor prognosis in HM/HSCT patients. Moreover, improvements in early diagnosis and treatment are urgently needed in these patients.

Mitigating the risk of transfusion-transmitted bacterial infections in hematology oncology patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19047-e19047
Author(s):  
Harold Alvarez ◽  
Marion Lanteri ◽  
Guenther Koehne
Keyword(s):  
Bacterial Infections ◽  
Bacterial Culture ◽  
Emerging Infectious Diseases ◽  
Bloodstream Infections ◽  
Central Line ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Life Saving ◽  
The Uk ◽  
Transfusion Reactions

e19047 Background: Hospital acquired infections create major logistical, financial, and patient safety concerns within the healthcare system. Bacterial contamination (BC) of platelet components (PCs) can lead to transfusion-transmitted bacterial infections (TTBI), central line-associated bloodstream infections, and sepsis, with long-term complications and/or death. In the US, hematopoietic stem cell transplant (HSCT) recipients require transfusion support until engraftment and together with hematology/oncology (hemonc.) patients receive the highest number of PCs/patient. FDA’s Guidance recommends approaches to reduce BC risk including the use of enhanced bacterial culture screening (EBSC) or pathogen reduction (PR) of platelets. Methods: The Miami Cancer Institute (MCI) implemented PR-PCs for all allogeneic HSCT patients. Irradiation, CMV testing, and bacterial screening have been discontinued for PR-PCs. Transfusion outcomes are being monitored using active hemovigilance (HV) reporting. Results: Considering the fatality risk associated with BC of PCs (1:200,000 – 1:1,000,000) despite the use of optimal skin cleansing, initial sample diversion, and primary bacterial culture, 1/2,880 PCs are still contaminated (Bloch et al.); further steps towards BC mitigation are needed. As the UK and US reported a residual BC risk of 5.4-9.4/million PCs after implementation of EBSC, PR may represent an alternative approach with other cumulative benefits. Indeed, national HV data from France, Switzerland and Belgium reported no sepsis transfusion reactions since PR implementation (Benjamin et al.). In addition, the risk of TA-GVHD and other TTI including emerging infectious diseases (EID) may be decreased after the inactivation of pathogens and leukocytes (Lanteri et al.). At MCI, the percentage of transfused PR-PCs has been increasing steadily from 7.9% in July 2019 to 22.2% in January 2021. Over a 19 month-period, a total of 9,296 PC were transfused including 1,677 PR-PCs. While non-PR-PCs were all irradiated and bacterially screened, PR-PC were neither irradiated nor bacterially screened. No cases of TA-GVHD or TTI were reported. A total of 27 mild, non-life-threatening platelet transfusion reactions were reported including 22 (81.5%) after non-PR PCs transfusion and 5 (18.5%) after PR-PC transfusion. In addition, the early release of transfusion-ready fresh PR-PCs 24-48 hours after collection has proven invaluable in providing clinicians and patients with blood continuity during the COVID-19 pandemic. Conclusions: Though certain measures have improved blood safety, the risk of TTI associated with PC transfusion remains a concern for vulnerable hemonc. patients. Using PR-PC is especially important to consider when patients undergo extensive life-saving therapies such as bone marrow transplants.

scholarly journals Acute and chronic graft versus host disease after hematopoietic stem cell transplant

JBMTCT ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 53-66
Author(s):  
Vaneuza A. M. Funke ◽  
Maria Claudia Rodrigues Moreira ◽  
Afonso Celso Vigorito
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Graft Versus Host Disease ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Cell Transplant ◽  
Primary Therapy ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host

Graft versus host disease is one of the main complications of Hematopoietic stem cell, in­volving about 50% to 80% of the patients. Acute GVHD clinical manifestations and therapy is discussed, as well as new NIH criteria for the diagnosis and classification of chronic GVHD. Therapy for both refractory chronic and acute GVHD is an important field of discussion once there is no superiority for the majority of the agents after primary therapy has failed. Hence, this review is meant to be a useful tool of consultation for clinicians who are dealing with this complex complication.

scholarly journals Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniaee Infections In A Tertiary Hospital In China

2021 ◽  
Author(s):  
Zhiwen Cui ◽  
Lirui Wang ◽  
Wei Chang ◽  
Minghui Li ◽  
Yuexia Li ◽  
...  
Keyword(s):  
Survival Time ◽  
Sofa Score ◽  
Clinical Characteristics ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drainage Fluid ◽  
Carbapenem Resistant ◽  
Antimicrobial Regimen

Abstract Background：The infections due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) have become an important problem. The aim of the study is to evaluate the clinical characteristics of CR-KP.Methods: A retrospective cohort study has been made on all patients presenting with CR-KP infections. 615 patients with CR-KP humor infections diagnosed were identified. 135 patients who did not meet the requirements were excluded. Clinical characteristics, antimicrobial regimens, and outcomes of patients have been analyzed.Results: The CR-KP infections overall mortality was 37.3%, and bloodstream infections mortality was 66.2%. Survival analysis revealed that there were statistically significant differences between bloodstream infection and pulmonary and drainage fluid infection. Logistics regression analysis showed that hemopathy, age (>60 years), solid tumors, diabetes, septic shock, acute kidney injury and stroke were independent predictors associated with the 30-day mortality. Multivariate linear regression was performed in APACHE II score, SOFA score, lymphocyte absolute value (LYM) and survival time. Survival time was negatively correlated with APACHE II score and SOFA score, while positively correlated with LYM. Finally, we investigated different antimicrobial regimens for CR-KP infections. Chi-square test showed that antimicrobial regimen combined carbapenems, tigecycline with polymyxin B was superior the one combined carbapenems with polymyxin B. Ceftazidime avibactam-based antimicrobial regimens also had no advantage over other therapeutic regimens.Conclusions: Our study confirmed there is a high mortality rate in CR-KP infections, especially in the bloodstream infections. The outcome is greatly influenced by the patients’ clinical conditions. Antimicrobial regimen combined carbapenems, tigecycline with polymyxin B might be a better choice.

scholarly journals Predictors of neutralizing antibody response to BNT162b2 vaccination in allogeneic hematopoietic stem cell transplant recipients

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Lorenzo Canti ◽  
Stéphanie Humblet-Baron ◽  
Isabelle Desombere ◽  
Julika Neumann ◽  
Pieter Pannus ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
T Cells ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Chronic Gvhd ◽  
Neutralizing Antibody ◽  
Healthy Adults ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Factors Affecting

Abstract Background Factors affecting response to SARS-CoV-2 mRNA vaccine in allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients remain to be elucidated. Methods Forty allo-HCT recipients were included in a study of immunization with BNT162b2 mRNA vaccine at days 0 and 21. Binding antibodies (Ab) to SARS-CoV-2 receptor binding domain (RBD) were assessed at days 0, 21, 28, and 49 while neutralizing Ab against SARS-CoV-2 wild type (NT50) were assessed at days 0 and 49. Results observed in allo-HCT patients were compared to those obtained in 40 healthy adults naive of SARS-CoV-2 infection. Flow cytometry analysis of peripheral blood cells was performed before vaccination to identify potential predictors of Ab responses. Results Three patients had detectable anti-RBD Ab before vaccination. Among the 37 SARS-CoV-2 naive patients, 20 (54%) and 32 (86%) patients had detectable anti-RBD Ab 21 days and 49 days postvaccination. Comparing anti-RBD Ab levels in allo-HCT recipients and healthy adults, we observed significantly lower anti-RBD Ab levels in allo-HCT recipients at days 21, 28 and 49. Further, 49% of allo-HCT patients versus 88% of healthy adults had detectable NT50 Ab at day 49 while allo-HCT recipients had significantly lower NT50 Ab titers than healthy adults (P = 0.0004). Ongoing moderate/severe chronic GVHD (P < 0.01) as well as rituximab administration in the year prior to vaccination (P < 0.05) correlated with low anti-RBD and NT50 Ab titers at 49 days after the first vaccination in multivariate analyses. Compared to healthy adults, allo-HCT patients without chronic GVHD or rituximab therapy had comparable anti-RBD Ab levels and NT50 Ab titers at day 49. Flow cytometry analyses before vaccination indicated that Ab responses in allo-HCT patients were strongly correlated with the number of memory B cells and of naive CD4+ T cells (r > 0.5, P < 0.01) and more weakly with the number of follicular helper T cells (r = 0.4, P = 0.01). Conclusions Chronic GVHD and rituximab administration in allo-HCT recipients are associated with reduced Ab responses to BNT162b2 vaccination. Immunological markers could help identify allo-HCT patients at risk of poor Ab response to mRNA vaccination. Trial registration The study was registered at clinicaltrialsregister.eu on 11 March 2021 (EudractCT # 2021-000673-83).

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