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Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: current challenges and pitfalls on empiric antibiotic treatment impacting outcomes

Bone Marrow Transplantation volume 55, pages 603–612 (2020)Cite this article

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Abstract

We aimed to describe epidemiology changes in bloodstream infections (BSI) episodes in hematopoietic stem cell transplant (HSCT) recipients throughout a 25-year period (1993–2017), comparing five-year time spans, and we evaluate their impact on inappropriate empirical antibiotic treatment (IEAT) and mortality. During the study period, 1164 BSI episodes were documented in patients undergoing HSCT (71.6% allogenic and 29% autologous). A significant decrease in gram-positive cocci (GPC) and increase in gram-negative bacilli (GNB) were observed (p < 0.001). Among GP, coagulase-negative staphylococci (CoNS) significantly decreased whereas rising E. faecium BSI was documented. Among GNB, E. coli, Pseudomonas aeruginosa and K. pneumoniae rates increased. Multidrug-resistant (MDR) GNB, especially ESBL-E. coli and MDR-P. aeruginosa, emerged in 2008 and has gradually increased. IEAT against MDR-P. aeruginosa, but not in other MDR-GNB, augmented throughout the study period. Overall, 30-day and related mortality rates were 12.7% and 7.7% respectively, both increasing over time (p < 0.001 and p = 0.025). In GNB, 30-day and related mortality were 18.5% and 12.8%, respectively, increasing over time (p < 0.001 and p = 0.004). To conclude, important BSI epidemiological changes were described in a 25-year period. Concerning increase in IEAT for P. aeruginosa infections and rising 30-day mortality rate were documented.

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Acknowledgements

This study was co-funded by a research grant from the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III [FIS PI18/01061], and a Regional Development Fund (ERDF). Dr. Pedro Puerta-Alcalde has received a pre-doctoral grant supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III [RH041828]. Dr. Carolina Garcia-Vidal has received the INTENSIFICACIÓ Grant- a grant supported by the Catalan Health Agency [PERIS (Pla estratègic de recerca i innovació en salut – “Strategic Plan for Research and Innovation in HealthCare”)]. Our group is recognized by the AGAUR (Project 2017SGR1432) of the Catalan Health Agency. We would like to thank the contributions made by Anthony Armenta in his corrections of the English language/syntax of the publication at hand.

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Authors and Affiliations

  1. Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain

    Pedro Puerta-Alcalde, Celia Cardozo, Estela Moreno, Laura Morata, Mariana Chumbita, Jose Antonio Martínez, Josep Mensa, Alex Soriano & Carolina Garcia-Vidal

  2. Microbiology Department, Centre Diagnòstic Biomèdic. Hospital Clínic, Barcelona, Spain

    Francesc Marco

  3. ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain

    Francesc Marco

  4. Hematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain

    Maria Suárez-Lledó, Francesc Fernández-Avilés, Gonzalo Gutiérrez-Garcia, Laura Rosiñol, Carmen Martínez, Álvaro Urbano & Montserrat Rovira

  5. University of Barcelona, Barcelona, Spain

    Gonzalo Gutiérrez-Garcia, Jose Antonio Martínez, Álvaro Urbano, Montserrat Rovira, Alex Soriano & Carolina Garcia-Vidal

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Correspondence to Pedro Puerta-Alcalde or Carolina Garcia-Vidal.

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CG-V has received honoraria for talks on behalf of Gilead Science, Merck Sharp and Dohme, Pfizer, Jannsen, Novartis, Lilly and a grant support from Gilead Science and Merck Sharp and Dohme. AS has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, Angellini, and a grant support from Pfizer.

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Puerta-Alcalde, P., Cardozo, C., Marco, F. et al. Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: current challenges and pitfalls on empiric antibiotic treatment impacting outcomes. Bone Marrow Transplant 55, 603–612 (2020). https://doi.org/10.1038/s41409-019-0701-3

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