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Post-Transplant Events

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Bone Marrow Transplantation volume 39, pages 775–781 (2007)Cite this article

Abstract

The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third- or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3.75–30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60–34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.

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Acknowledgements

The following investigators contributed to data collection: Vergilio Antonio Rensi Colturato, Lílian Piron-Ruiz, Ana Paula Gallo, Marcos Roberto Lago, Marcos Augusto Mauad, Wellington Moraes Azevedo, José Carlos Barros, Nelson Siqueira de Castro, Carlos Alberto Pires Pereira, Roseane Vasconcelos Gouveia and Claudia Mangini. Financial support: This work was supported in part by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil (Grant 300235/93-3).

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  1. M A Ruiz

    Present address: Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.,

Authors and Affiliations

  1. Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    A L Oliveira, A Maiolino & M Nucci

  2. Hospital Amaral Carvalho, Jaú, Brazil

    M de Souza & P Urakawa

  3. Hospital das Clínicas, Universidade Federal do Paraná, Curitiba, Brazil

    V M H Carvalho-Dias, C A Cunha & R Pasquini

  4. Hospital de Base, São José do Rio Preto, Brazil

    M A Ruiz

  5. Hospital das Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    L Silla

  6. Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil

    P Yurie Tanaka

  7. Hospital das Clínicas, Universidade de São Paulo, Ribeirão Preto, Brazil

    B P Simões

  8. Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, Brazil

    P Trabasso & C A de Souza

  9. Instituto de Oncologia Pediátrica – GRAAC – UNIFESP, São Paulo, Brazil

    A Seber

  10. Hospital AC Camargo, São Paulo, Brazil

    C J Lotfi

  11. Hospital Brigadeiro, São Paulo, Brazil

    M A Zanichelli

  12. Centro de Pesquisas Oncológicas, Florianópolis, Brazil

    V R Araujo

  13. Hospital Araújo Jorge, Goiânia, Brazil

    C Godoy

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Correspondence to M Nucci.

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Oliveira, A., de Souza, M., Carvalho-Dias, V. et al. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 39, 775–781 (2007). https://doi.org/10.1038/sj.bmt.1705677

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  • DOI: https://doi.org/10.1038/sj.bmt.1705677

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