Abstract
The purpose of this study was to analyse risk factors for blood stream infection (BSI) and pneumonia in neutropenic patients who have undergone peripheral blood stem-cell transplantation (PBSCT). Data were taken from the ONKO-KISS multicenter surveillance project. Infections were identified using CDC definitions (laboratory-confirmed BSI) and modified criteria for pneumonia in neutropenic patients. The multivariate analysis was performed using the Fine–Gray regression model for the cumulative incidences of the competing events ‘infection’, ‘death’ and ‘end of neutropenia’. The risk factors investigated were: sex, age, underlying disease and type of transplant. From January 2000 to June 2004, a total of 1699 patients in 20 hospitals were investigated. In the multivariate analysis, male patients had a significantly higher risk of acquiring BSI than female patients (P=0.002). The risk of acquiring BSI is highest in patients with advanced acute myeloid leukaemia (AML). In the univariate and multivariate analysis, unrelated donor allogeneic transplantation constituted a risk factor for pneumonia (P=0.012). ONKO-KISS provides reference data on the incidence of pneumonia and BSI. The increased risk for BSI in males and patients with advanced AML, and the increased risk for pneumonia in unrelated donor allogeneic PBSCT patients should be targeted to prevent infections in these higher risk groups.
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References
Dettenkofer M, Ebner W, Bertz H, Babikir R, Finke J, Frank U et al. Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 2003; 31: 795–801.
Engelhart S, Glasmacher A, Exner M, Kramer MH . Surveillance for nosocomial infections and fever of unknown origin among adult hematology-oncology patients. Infect Control Hosp Epidemiol 2002; 23: 244–248.
Dettenkofer M, Wenzler-Rottele S, Babikir R, Bertz H, Ebner W, Meyer E et al. Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project. Clin Infect Dis 2005; 40: 926–931.
Klein JP, Rizzo JD, Zhang MJ, Keiding N . Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part 2: regression modeling. Bone Marrow Transplant 2001; 28: 1001–1011.
Klein JP, Rizzo JD, Zhang MJ, Keiding N . Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: unadjusted analysis. Bone Marrow Transplant 2001; 28: 909–915.
Fine JP, Gray RJ . A proportional hazards model for the subdistribution of a competing risks. J Am Statist Assoc 1999; 94: 496–509.
Andersen PK, Abildstrom SZ, Rosthoj S . Competing risks as a multi-state model. Statist Methods Med Res 2005; 11: 203–215.
Martelli G, Miceli R, De Palo G, Coradini D, Salvadori B, Zucali R et al. Is axillary lymph node dissection necessary in elderly patients with breast carcinoma who have a clinically uninvolved axilla? Cancer 2003; 97: 1156–1163.
R Development Core Team. A Language and Environment for Statistical Computing. Vienna, Austria, 2004.
Lu K, Tsiatis AA . Multiple imputation methods for estimating regression coefficients in the competing risks model with missing cause of failure. Biometrics 2001; 57: 1191–1197.
TerÄasvirta T, Mellin I . Model selection criteria and model selection tests in regression models. Scand J Statist 1986; 13: 159.
Carlisle PS, Gucalp R, Wiernik PH . Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993; 14: 320–324.
Kolbe K, Domkin D, Derigs HG, Bhakdi S, Huber C, Aulitzky WE . Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 1997; 19: 143–147.
Marena C, Zecca M, Carenini ML, Bruschi A, Bassi ML, Olivieri P et al. Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality. Infect Control Hosp Epidemiol 2001; 22: 510–517.
Martin GS, Mannino DM, Eaton S, Moss M . The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546–1554.
Danai PA, Moss M, Mannino DM, Martin GS . The epidemiology of sepsis in patients with malignancy. Chest 2006; 129: 1432–1440.
Gannon CJ, Pasquale M, Tracy JK, McCarter RJ, Napolitano LM . Male gender is associated with increased risk for postinjury pneumonia. Shock 2004; 21: 410–414.
Bauer I, Bauer M, Raddatz A, Luedtke C, Werth M, Silomon M et al. Influence of gender on stimulated cytokine response in patients with severe sepsis. Anaesthesist 2006; 55: 515–527.
Chan-Yeung M, Noertjojo K, Chan SL, Tam CM . Sex differences in tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2002; 6: 11–18.
Laupland KB, Church DL, Mucenski M, Sutherland LR, Davies HD . Population-based study of the epidemiology of and the risk factors for invasive Staphylococcus aureus infections. J Infect Dis 2003; 187: 1452–1459.
Huff GR, Huff WE, Balog JM, Rath NC . Sex differences in the resistance of turkeys to Escherichia coli challenge after immunosuppression with dexamethasone. Poult Sci 1999; 78: 38–44.
Sadeghi M, Daniel V, Naujokat C, Wiesel M, Hergesell O, Opelz G . Strong inflammatory cytokine response in male and strong anti-inflammatory response in female kidney transplant recipients with urinary tract infection. Transpl Int 2005; 18: 177–185.
Lynch EA, Dinarello CA, Cannon JG . Gender differences in IL-1 alpha, IL-1 beta, and IL-1 receptor antagonist secretion from mononuclear cells and urinary excretion. J Immunol 1994; 153: 300–306.
Rex JH, Anaissie EJ, Boutati E, Estey E, Kantarjian H . Systemic antifungal prophylaxis reduces invasive fungal in acute myelogenous leukemia: a retrospective review of 833 episodes of neutropenia in 322 adults. Leukemia 2002; 16: 1197–1199.
Madani TA . Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia. Infection 2000; 28: 367–373.
Junghanss C, Marr KA, Carter RA, Sandmaier BM, Maris MB, Maloney DG et al. Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study. Biol Blood Marrow Transplant 2002; 8: 512–520.
Acknowledgements
We thank the medical staff and study nurses at all participating centers for their invaluable support throughout the study. This project received financial support from Federal Ministry of Health, Germany.
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Meyer, E., Beyersmann, J., Bertz, H. et al. Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant 39, 173–178 (2007). https://doi.org/10.1038/sj.bmt.1705561
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DOI: https://doi.org/10.1038/sj.bmt.1705561
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