Incidence, Risk Factors, and Outcomes of Patients Who Develop Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infections in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplant

• Published in: JAMA network open 2020-01, Vol.3 (1), p.e1918668-e1918668
• Main Authors: Dandoy, Christopher E, Kim, Soyoung, Chen, Min, Ahn, Kwang Woo, Ardura, Monica I, Brown, Valerie, Chhabra, Saurabh, Diaz, Miguel Angel, Dvorak, Christopher, Farhadfar, Nosha, Flagg, Aron, Ganguly, Siddartha, Hale, Gregory A, Hashmi, Shahrukh K, Hematti, Peiman, Martino, Rodrigo, Nishihori, Taiga, Nusrat, Roomi, Olsson, Richard F, Rotz, Seth J, Sung, Anthony D, Perales, Miguel-Angel, Lindemans, Caroline A, Komanduri, Krishna V, Riches, Marcie L
• Format: Article
• Language: English
• Subjects: Graft versus host disease; Infections; Laboratories; Medicin och hälsovetenskap; Mortality; Oncology; Online Only; Original Investigation; Risk factors; Stem cell transplantation
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2019.18668

Patients undergoing hematopoietic stem cell transplant (HSCT) are at risk for bloodstream infection (BSI) secondary to translocation of bacteria through the injured mucosa, termed mucosal barrier injury-laboratory confirmed bloodstream infection (MBI-LCBI), in addition to BSI secondary to indwelling catheters and infection at other sites (BSI-other). To determine the incidence, timing, risk factors, and outcomes of patients who develop MBI-LCBI in the first 100 days after HSCT. A case-cohort retrospective analysis was performed using data from the Center for International Blood and Marrow Transplant Research database on 16 875 consecutive pediatric and adult patients receiving a first allogeneic HSCT from January 1, 2009, to December 31, 2016. Patients were classified into 4 categories: MBI-LCBI (1481 [8.8%]), MBI-LCBI and BSI-other (698 [4.1%]), BSI-other only (2928 [17.4%]), and controls with no BSI (11 768 [69.7%]). Statistical analysis was performed from April 5 to July 17, 2018. Demographic characteristics and outcomes, including overall survival, chronic graft-vs-host disease, and transplant-related mortality (only for patients with malignant disease), were compared among groups. Of the 16 875 patients in the study (9737 [57.7%] male; median [range] age, 47 [0.04-82] years) 13 686 (81.1%) underwent HSCT for a malignant neoplasm, and 3189 (18.9%) underwent HSCT for a nonmalignant condition. The cumulative incidence of MBI-LCBI was 13% (99% CI, 12%-13%) by day 100, and the cumulative incidence of BSI-other was 21% (99% CI, 21%-22%) by day 100. Median (range) time from transplant to first MBI-LCBI was 8 (