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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
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...
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| Published in: | JAMA network open 2020-01, Vol.3 (1), p.e1918668-e1918668 |
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| creator | 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 |
| description | 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 ( |
| doi_str_mv | 10.1001/jamanetworkopen.2019.18668 |
| format | article |
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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 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]).
In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2019.18668</identifier><identifier>PMID: 31913492</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Graft versus host disease ; Infections ; Laboratories ; Mortality ; Oncology ; Online Only ; Original Investigation ; Risk factors ; Stem cell transplantation</subject><ispartof>JAMA network open, 2020-01, Vol.3 (1), p.e1918668-e1918668</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2020 Dandoy CE et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a614t-b024bffdf2e6d931d392f320ae4c1feb42418adb21c6a2f1170423b2e91dddc13</citedby><cites>FETCH-LOGICAL-a614t-b024bffdf2e6d931d392f320ae4c1feb42418adb21c6a2f1170423b2e91dddc13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2668181492?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,25752,27923,27924,37011,37012,44589</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31913492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-434444$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:145559644$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Dandoy, Christopher E</creatorcontrib><creatorcontrib>Kim, Soyoung</creatorcontrib><creatorcontrib>Chen, Min</creatorcontrib><creatorcontrib>Ahn, Kwang Woo</creatorcontrib><creatorcontrib>Ardura, Monica I</creatorcontrib><creatorcontrib>Brown, Valerie</creatorcontrib><creatorcontrib>Chhabra, Saurabh</creatorcontrib><creatorcontrib>Diaz, Miguel Angel</creatorcontrib><creatorcontrib>Dvorak, Christopher</creatorcontrib><creatorcontrib>Farhadfar, Nosha</creatorcontrib><creatorcontrib>Flagg, Aron</creatorcontrib><creatorcontrib>Ganguly, Siddartha</creatorcontrib><creatorcontrib>Hale, Gregory A</creatorcontrib><creatorcontrib>Hashmi, Shahrukh K</creatorcontrib><creatorcontrib>Hematti, Peiman</creatorcontrib><creatorcontrib>Martino, Rodrigo</creatorcontrib><creatorcontrib>Nishihori, Taiga</creatorcontrib><creatorcontrib>Nusrat, Roomi</creatorcontrib><creatorcontrib>Olsson, Richard F</creatorcontrib><creatorcontrib>Rotz, Seth J</creatorcontrib><creatorcontrib>Sung, Anthony D</creatorcontrib><creatorcontrib>Perales, Miguel-Angel</creatorcontrib><creatorcontrib>Lindemans, Caroline A</creatorcontrib><creatorcontrib>Komanduri, Krishna V</creatorcontrib><creatorcontrib>Riches, Marcie L</creatorcontrib><title>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</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>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 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]).
In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.</description><subject>Graft versus host disease</subject><subject>Infections</subject><subject>Laboratories</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Risk factors</subject><subject>Stem cell transplantation</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNp1kl1v0zAUhiMEYtPYX0AW3HDRlPijacwFUtdSVqloCAZcWo5z0rpN7Mx2NvUv8qtwaZm2SfjGX8957fPqTZI3OBviLMPvN7KVBsKddVvbgRmSDPMhLvK8eJacktGYpbTIRs8frE-Sc-83WZZFlPJ89DI5oZhjyjg5TX4vjNIVGAUD9E37LZpLFazzAyRNha76oGwLHtkafZVBgwke_VpbNINbaGyHvvTKetmgC-mcBocWZtO7XbqUpXUy6uzQ1JpauxYqdNFYW_ngQLaRq0EFbY1H2qCwBjTXzgcUW0QzufNoUocoN2kauwIDWqFLaKNgZzWEuPseoEVTaBp07aTxXSNNeJW8qGXj4fw4nyU_5p-up5fp8urzYjpZpjLHLKRlRlhZ11VNIK84xRXlpKYkk8AUrqFkhOFCViXBKpekxnicMUJLAhxXVaUwPUvSg66_g64vRed0K91OWKnF8WgbVyDYmDHKIz_4Lz_TPyfCupXoe8EoiyPiHw94ZKNtKnruZPOo6vGN0Wuxsrci5xwTlkeBd0cBZ2968EG02qvoVcyN7b0glLKcF4Tv33r7BN3Y3pnoniAxUbjAMSSR-nCglLPeO6jvP4MzsQ-leBJKsQ-l-BvKWPz6YTv3pf8iSP8A-cPoOA</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Dandoy, Christopher E</creator><creator>Kim, Soyoung</creator><creator>Chen, Min</creator><creator>Ahn, Kwang Woo</creator><creator>Ardura, Monica I</creator><creator>Brown, Valerie</creator><creator>Chhabra, Saurabh</creator><creator>Diaz, Miguel Angel</creator><creator>Dvorak, Christopher</creator><creator>Farhadfar, Nosha</creator><creator>Flagg, Aron</creator><creator>Ganguly, Siddartha</creator><creator>Hale, Gregory A</creator><creator>Hashmi, Shahrukh K</creator><creator>Hematti, Peiman</creator><creator>Martino, Rodrigo</creator><creator>Nishihori, Taiga</creator><creator>Nusrat, Roomi</creator><creator>Olsson, Richard F</creator><creator>Rotz, Seth J</creator><creator>Sung, Anthony D</creator><creator>Perales, Miguel-Angel</creator><creator>Lindemans, Caroline A</creator><creator>Komanduri, Krishna V</creator><creator>Riches, Marcie L</creator><general>American Medical 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; 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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a614t-b024bffdf2e6d931d392f320ae4c1feb42418adb21c6a2f1170423b2e91dddc13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Graft versus host disease</topic><topic>Infections</topic><topic>Laboratories</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Risk factors</topic><topic>Stem cell transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dandoy, Christopher E</creatorcontrib><creatorcontrib>Kim, Soyoung</creatorcontrib><creatorcontrib>Chen, Min</creatorcontrib><creatorcontrib>Ahn, Kwang Woo</creatorcontrib><creatorcontrib>Ardura, Monica I</creatorcontrib><creatorcontrib>Brown, Valerie</creatorcontrib><creatorcontrib>Chhabra, Saurabh</creatorcontrib><creatorcontrib>Diaz, Miguel Angel</creatorcontrib><creatorcontrib>Dvorak, Christopher</creatorcontrib><creatorcontrib>Farhadfar, Nosha</creatorcontrib><creatorcontrib>Flagg, Aron</creatorcontrib><creatorcontrib>Ganguly, Siddartha</creatorcontrib><creatorcontrib>Hale, Gregory A</creatorcontrib><creatorcontrib>Hashmi, Shahrukh K</creatorcontrib><creatorcontrib>Hematti, Peiman</creatorcontrib><creatorcontrib>Martino, Rodrigo</creatorcontrib><creatorcontrib>Nishihori, Taiga</creatorcontrib><creatorcontrib>Nusrat, Roomi</creatorcontrib><creatorcontrib>Olsson, Richard F</creatorcontrib><creatorcontrib>Rotz, Seth J</creatorcontrib><creatorcontrib>Sung, Anthony D</creatorcontrib><creatorcontrib>Perales, Miguel-Angel</creatorcontrib><creatorcontrib>Lindemans, Caroline A</creatorcontrib><creatorcontrib>Komanduri, Krishna V</creatorcontrib><creatorcontrib>Riches, Marcie L</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community 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text</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dandoy, Christopher E</au><au>Kim, Soyoung</au><au>Chen, Min</au><au>Ahn, Kwang Woo</au><au>Ardura, Monica I</au><au>Brown, Valerie</au><au>Chhabra, Saurabh</au><au>Diaz, Miguel Angel</au><au>Dvorak, Christopher</au><au>Farhadfar, Nosha</au><au>Flagg, Aron</au><au>Ganguly, Siddartha</au><au>Hale, Gregory A</au><au>Hashmi, Shahrukh K</au><au>Hematti, Peiman</au><au>Martino, Rodrigo</au><au>Nishihori, Taiga</au><au>Nusrat, Roomi</au><au>Olsson, Richard F</au><au>Rotz, Seth J</au><au>Sung, Anthony D</au><au>Perales, Miguel-Angel</au><au>Lindemans, Caroline A</au><au>Komanduri, Krishna V</au><au>Riches, Marcie L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>3</volume><issue>1</issue><spage>e1918668</spage><epage>e1918668</epage><pages>e1918668-e1918668</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>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 (<1 to 98) days vs 29 (<1 to 100) days for BSI-other. Multivariable analysis revealed an increased risk of MBI-LCBI with poor Karnofsky/Lansky performance status (hazard ratio [HR], 1.21 [99% CI, 1.04-1.41]), cord blood grafts (HR, 2.89 [99% CI, 1.97-4.24]), myeloablative conditioning (HR, 1.46 [99% CI, 1.19-1.78]), and posttransplant cyclophosphamide graft-vs-host disease prophylaxis (HR, 1.85 [99% CI, 1.38-2.48]). One-year mortality was significantly higher for patients with MBI-LCBI (HR, 1.81 [99% CI, 1.56-2.12]), BSI-other (HR, 1.81 [99% CI, 1.60-2.06]), and MBI-LCBI plus BSI-other (HR, 2.65 [99% CI, 2.17-3.24]) compared with controls. Infection was more commonly reported as a cause of death for patients with MBI-LCBI (139 of 740 [18.8%]), BSI (251 of 1537 [16.3%]), and MBI-LCBI plus BSI (94 of 435 [21.6%]) than for controls (566 of 4740 [11.9%]).
In this cohort study, MBI-LCBI, in addition to any BSIs, were associated with significant morbidity and mortality after HSCT. Further investigation into risk reduction should be a clinical and scientific priority in this patient population.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>31913492</pmid><doi>10.1001/jamanetworkopen.2019.18668</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2574-3805 |
| ispartof | JAMA network open, 2020-01, Vol.3 (1), p.e1918668-e1918668 |
| issn | 2574-3805 2574-3805 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_474439 |
| source | Publicly Available Content Database |
| subjects | Graft versus host disease Infections Laboratories Mortality Oncology Online Only Original Investigation Risk factors Stem cell transplantation |
| title | 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 |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-11T01%3A37%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Incidence,%20Risk%20Factors,%20and%20Outcomes%20of%20Patients%20Who%20Develop%20Mucosal%20Barrier%20Injury-Laboratory%20Confirmed%20Bloodstream%20Infections%20in%20the%20First%20100%20Days%20After%20Allogeneic%20Hematopoietic%20Stem%20Cell%20Transplant&rft.jtitle=JAMA%20network%20open&rft.au=Dandoy,%20Christopher%20E&rft.date=2020-01-01&rft.volume=3&rft.issue=1&rft.spage=e1918668&rft.epage=e1918668&rft.pages=e1918668-e1918668&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2019.18668&rft_dat=%3Cproquest_swepu%3E2334698294%3C/proquest_swepu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-a614t-b024bffdf2e6d931d392f320ae4c1feb42418adb21c6a2f1170423b2e91dddc13%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2668181492&rft_id=info:pmid/31913492&rfr_iscdi=true |