Incidence, Risk Factors, and Outcomes of Bloodstream Infection during Conditioning Phase before Allogeneic Hematopoietic Stem Cell Transplantation.

IF 4.4 3区医学 Q2 HEMATOLOGY

Transplantation and Cellular Therapy Pub Date : 2025-06-25 DOI:10.1016/j.jtct.2025.05.027

Ling Pan, Jia Li, Qingsong Lin, Xiaomeng Feng, Xueyuan Li, Guixin Zhang, Sisi Zhen, Yuqing Cui, Jieru Wang, Yuping Fan, Tingting Zhang, Yigeng Cao, Wenbin Cao, Aiming Pang, Donglin Yang, Xin Chen, Rongli Zhang, Jialin Wei, Qiaoling Ma, Weihua Zhai, Yi He, Mingzhe Han, Erlie Jiang, Sizhou Feng

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Abstract

Bloodstream infections (BSI) pose critical risks during allogeneic hematopoietic stem cell transplantation (allo-HSCT), yet data on BSI during the conditioning phase remain limited. To assess the characteristics, risk factors, and outcomes of BSI during conditioning in allo-HSCT patients with hematological diseases. We conducted a single-center retrospective cohort study including 2395 consecutive allo-HSCT recipients between September 2013 and September 2023. BSI occurred in 113 patients (5.7% cumulative incidence), with median onset on day -2. Monomicrobial Gram-negative bacteria (73.5%, 83/113) and Gram-positive bacteria (18.6%, 21/113) predominated, with polymicrobial BSI in 8.0% (9/113). Carbapenem-resistant Gram-negative organisms (CRO) constituted 15.9% (18/113) of infections. Independent BSI risk factors included antithymocyte globulin (ATG)-mediated conditioning (96.5% of BSI cases), aplastic anemia (AA), hematopoietic cell transplantation-comorbidity index (HCT-CI) ≥2, and preconditioning neutropenia ≥7 days. Patients were stratified by risk based on cumulative incidence: low (0 factor ± ATG, 3.3%), intermediate (ATG + 1 factor, 9.3%), and high (ATG + ≥ 2 factors, 21.4%) (P < .001). BSI significantly reduced 28-day survival (94.7% versus 99.7%, P < .001), with 5.3% mortality (6/113). CRO BSI exhibited lower survival than non-CRO cases (76.5% versus 97.9%, P < .001). Prior CRO colonization independently predicted CRO BSI (P = .003). Appropriate empirical therapy and ceftazidime/avibactam (CAZ-AVI)-based definitive regimens improved early survival. BSI surveillance should prioritize patients undergoing ATG-based conditioning, particularly those with AA, HCT-CI ≥ 2, or preconditioning neutropenia ≥7 days. Given the dominant mortality risk of CRO BSI during conditioning, pre-HSCT CRO screening is imperative, and targeted therapies such as CAZ-AVI are critical.

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异基因造血干细胞移植前适应期血流感染的发生率、危险因素和结果

背景：血液感染（BSI）在同种异体造血干细胞移植（alloo - hsct）过程中会造成严重的风险，然而适应期BSI的数据仍然有限。目的：评估同种异体造血干细胞移植合并血液病患者适应过程中BSI的特征、危险因素和预后。研究设计：我们在2013年9月至2023年9月期间进行了一项单中心回顾性队列研究，包括2395名连续的同种异体造血干细胞移植接受者。结果：113例患者发生BSI（累计发病率5.7%），中位发病时间为第2天。革兰氏阴性菌占73.5%(83/113)，革兰氏阳性菌占18.6%(21/113)，多菌BSI占8.0%（9/113）。耐碳青霉烯革兰氏阴性菌（CRO）占15.9%（18/113）。BSI的独立危险因素包括抗胸腺细胞球蛋白（ATG）介导的调节（96.5%的BSI病例）、再生障碍性贫血（AA）、造血细胞移植合并症指数(HCT-CI)≥2、预处理中性粒细胞减少≥7天。根据累积发病率对患者进行风险分层：低（0因素±ATG， 3.3%）、中（ATG + 1因素，9.3%）、高（ATG + ≥2因素，21.4%）（p < 0.001）。BSI显著降低28天生存率（94.7% vs. 99.7%, p < 0.001），死亡率5.3%（6/113）。CRO BSI患者的生存率低于非CRO患者（76.5% vs. 97.9%, p < 0.001）。先前的CRO定殖独立预测CRO BSI （p = 0.003）。适当的经验治疗和头孢他啶/阿维巴坦（CAZ-AVI）为基础的最终方案改善了早期生存。结论：BSI监测应优先考虑接受atg调节的患者，特别是AA、HCT-CI≥2或预处理中性粒细胞减少≥7天的患者。考虑到适应过程中CRO BSI的主要死亡风险，hsct前CRO筛查是必要的，靶向治疗如CAZ-AVI是至关重要的。

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