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Post-Transplant Events

Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 45, pages 521–526 (2010)Cite this article

Abstract

Induction/consolidation chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT) for hematological malignancies are associated with treatment-related risks such as infections. The predominant types of infections are blood stream infections (BSIs) and respiratory tract infections. We prospectively compared infectious complications after induction/consolidation chemotherapy versus allogeneic HSCT in a directly comparable setting with both groups being hospitalized on the same ward. From July 2003 until June 2008, 492 hospitalizations of 321 patients took place; 237 chemotherapies and 255 HSCTs were performed. We observed 49 (20.7%) BSIs, 70 (29.5%) pneumonias and 11 (4.6%) probable or proven invasive mould infections in the chemotherapy group. In the HSCT group we detected 70 (27.5%) BSIs, 71 (27.8%) pneumonias and 14 (5.4%) probable or proven invasive mould infections. There was a trend toward more transfers to the intensive care unit (OR 1.61; 95%CI 0.95–2.72; P=0.074) and BSIs (OR 1.45; 95%CI 0.95–2.22; P=0.079) after HSCT; 44 (13.7%) patients died. In-hospital mortality was significantly higher in the HSCT group (OR 2.39; 95%CI 1.22–4.68; P=0.010). We conclude that the risk of pneumonia and invasive mould infection is comparable after induction/consolidation chemotherapy and allogeneic HSCT. However, there was a trend for more BSIs and intensive care unit stays and a higher mortality in the latter.

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References

  1. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 2007; 356: 348–359.

    Article  CAS  PubMed  Google Scholar 

  2. Bow EJ, Laverdiere M, Lussier N, Rotstein C, Cheang MS, Ioannou S . Antifungal prophylaxis for severely neutropenic chemotherapy recipients: a meta analysis of randomized-controlled clinical trials. Cancer 2002; 94: 3230–3246.

    Article  CAS  PubMed  Google Scholar 

  3. Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G et al. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005; 353: 977–987.

    Article  CAS  PubMed  Google Scholar 

  4. Cordonnier C, Ribaud P, Herbrecht R, Milpied N, Valteau-Couanet D, Morgan C et al. Prognostic factors for death due to invasive aspergillosis after hematopoietic stem cell transplantation: a 1-year retrospective study of consecutive patients at French transplantation centers. Clin Infect Dis 2006; 42: 955–963.

    Article  CAS  PubMed  Google Scholar 

  5. Marr KA, Carter RA, Boeckh M, Martin P, Corey L . Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002; 100: 4358–4366.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. Meyer E, Beyersmann J, Bertz H, Wenzler-Rottele S, Babikir R, Schumacher M et al. Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant 2007; 39: 173–178.

    Article  CAS  PubMed  Google Scholar 

  8. Viscoli C, Cometta A, Kern WV, Bock R, Paesmans M, Crokaert F et al. Piperacillin-tazobactam monotherapy in high-risk febrile and neutropenic cancer patients. Clin Microbiol Infect 2006; 12: 212–216.

    Article  CAS  PubMed  Google Scholar 

  9. Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR . Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant 2007; 40: 63–70.

    Article  CAS  PubMed  Google Scholar 

  10. Ninin E, Milpied N, Moreau P, Andre-Richet B, Morineau N, Mahe B et al. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001; 33: 41–47.

    Article  CAS  PubMed  Google Scholar 

  11. Sanz MA, Lopez J, Lahuerta JJ, Rovira M, Batlle M, Perez C et al. Cefepime plus amikacin versus piperacillin-tazobactam plus amikacin for initial antibiotic therapy in haematology patients with febrile neutropenia: results of an open, randomized, multicentre trial. J Antimicrob Chemother 2002; 50: 79–88.

    Article  CAS  PubMed  Google Scholar 

  12. Akova M, Paesmans M, Calandra T, Viscoli C . A European Organization for Research and Treatment of Cancer-International Antimicrobial Therapy Group Study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 2005; 40: 239–245.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. Winston DJ, Maziarz RT, Chandrasekar PH, Lazarus HM, Goldman M, Blumer JL et al. Intravenous and oral itraconazole versus intravenous and oral fluconazole for long-term antifungal prophylaxis in allogeneic hematopoietic stem-cell transplant recipients. A multicenter, randomized trial. Ann Intern Med 2003; 138: 705–713.

    Article  CAS  PubMed  Google Scholar 

  15. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91: 1068–1075.

    PubMed  Google Scholar 

  16. Barnes PD, Marr KA . Risks, diagnosis and outcomes of invasive fungal infections in haematopoietic stem cell transplant recipients. Br J Haematol 2007; 139: 519–531.

    Article  PubMed  Google Scholar 

  17. Lin SJ, Schranz J, Teutsch SM . Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358–366.

    Article  CAS  PubMed  Google Scholar 

  18. Gudlaugsson O, Gillespie S, Lee K, Vande Berg J, Hu J, Messer S et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003; 37: 1172–1177.

    Article  PubMed  Google Scholar 

  19. Denning DW . Therapeutic outcome in invasive aspergillosis. Clin Infect Dis 1996; 23: 608–615.

    Article  CAS  PubMed  Google Scholar 

  20. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002; 34: 730–751.

    Article  PubMed  Google Scholar 

  21. Gaynes RP, TH . Surveillance of nosocomial infections. Appendix: a CDC definitions of nosocomial infections. In: Mayhall CG (eds). Hospital Epidemiology and Infections Control, 2nd edn Lippincott Williams & Wilkins: Philadelphia, 1999 pp 1296–1307.

    Google Scholar 

  22. Carlisle PS, Gucalp R, Wiernik PH . Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993; 14: 320–324.

    Article  CAS  PubMed  Google Scholar 

  23. Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.

    Article  CAS  PubMed  Google Scholar 

  24. Gastmeier P, Sohr D, Just HM, Nassauer A, Daschner F, Ruden H . How to survey nosocomial infections. Infect Control Hosp Epidemiol 2000; 21: 366–370.

    Article  CAS  PubMed  Google Scholar 

  25. Link H, Maschmeyer G, Meyer P, Hiddemann W, Stille W, Helmerking M et al. Interventional antimicrobial therapy in febrile neutropenic patients. Study Group of the Paul Ehrlich Society for Chemotherapy. Ann Hematol 1994; 69: 231–243.

    Article  CAS  PubMed  Google Scholar 

  26. De Pauw BE, Deresinski SC, Feld R, Lane-Allman EF, Donnelly JP . Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. The Intercontinental Antimicrobial Study Group. Ann Intern Med 1994; 120: 834–844.

    Article  CAS  PubMed  Google Scholar 

  27. Freifeld AG, Walsh T, Marshall D, Gress J, Steinberg SM, Hathorn J et al. Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem. J Clin Oncol 1995; 13: 165–176.

    Article  CAS  PubMed  Google Scholar 

  28. Rupp ME, Lisco SJ, Lipsett PA, Perl TM, Keating K, Civetta JM et al. Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med 2005; 143: 570–580.

    Article  CAS  PubMed  Google Scholar 

  29. Mettler J, Simcock M, Sendi P, Widmer AF, Bingisser R, Battegay M et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis 2007; 7: 21.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Collin BA, Leather HL, Wingard JR, Ramphal R . Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001; 33: 947–953.

    Article  CAS  PubMed  Google Scholar 

  31. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP . Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999; 29: 239–244.

    Article  CAS  PubMed  Google Scholar 

  32. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB . Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39: 309–317.

    Article  PubMed  Google Scholar 

  33. Khanna N, Widmer AF, Decker M, Steffen I, Halter J, Heim D et al. Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature. Clin Infect Dis 2008; 46: 402–412.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank the Altana Fonds, University Hospital Basel, for the unrestricted financial support of this study.

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Author notes

  1. C Orasch and M Weisser: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

    C Orasch, M Weisser, D Mertz, A Conen, M Battegay, A Widmer & U Flückiger

  2. Division of Hematology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

    D Heim, S Christen & A Gratwohl

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  1. C Orasch
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Correspondence to U Flückiger.

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Orasch, C., Weisser, M., Mertz, D. et al. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 45, 521–526 (2010). https://doi.org/10.1038/bmt.2009.187

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