Yemişen M, et al: Epidemiology <strong>of</strong> Bloodstream Infections Turk J Hematol 2016;<strong>33</strong>:216-222 Univariate analysis to determine risk factors for bacteremia identified HSCT type, any comorbidity, duration <strong>of</strong> engraftment longer than 10 days, and GVHD grade <strong>of</strong> 2-4 (p
Turk J Hematol 2016;<strong>33</strong>:216-222 Yemişen M, et al: Epidemiology <strong>of</strong> Bloodstream Infections Our study had some limitations. It was performed retrospectively and, due to missing data, some patients had to be excluded. The initial empiric antibiotic treatment might have influenced the resistance <strong>of</strong> the bacteria, but we could not account for the effect <strong>of</strong> empiric antibiotic treatment. The impact <strong>of</strong> the stem cell source on bacteremia in allogeneic HSCT recipients could not be analyzed since almost all patients received peripheral stem cells from fully matched donors. In conclusion, BSI in HSCT recipients is still a great problem. The global switch from a gram-negative etiology to a grampositive one was also observed in our study. In addition to other gram-negative bacteria, A. baumannii and S. maltophilia were frequent causes <strong>of</strong> bacteremia but were generally not covered by initial empirical therapy. Accordingly, we observed a higher rate <strong>of</strong> mortality due to S. maltophilia bacteremia. It is generally difficult to identify the source <strong>of</strong> bacteremia in HSCT patients. In our study, CVCs were the only source suggested and they were usually associated with unusual pathogens. However, with a dedicated CVC team and the use <strong>of</strong> a catheter-care bundle, we could reduce the rate <strong>of</strong> catheter-related BSIs. HSCT recipients are especially at risk <strong>of</strong> CVC-related BSIs, which may include difficult-to-treat pathogens. Ethics Ethics Committee Approval: Retrospective study; Informed Consent: It was taken. Authorship Contributions Concept: Mücahit Yemişen, İlker İnanç Balkan; Design: Mücahit Yemişen, Ahmet Emre Eşkazan; Data Collection or Processing: Mücahit Yemişen, İlker İnanç Balkan, Ayşe Salihoğlu, Ahmet Emre Eşkazan, Bilgül Mete, M. Cem Ar, Şeniz Öngören, Zafer Başlar, Reşat Özaras, Neşe Saltoğlu, Ali Mert, Burhan Ferhanoğlu, Recep Öztürk, Fehmi Tabak, Teoman Soysal; Analysis or Interpretation: Mücahit Yemişen, İlker İnanç Balkan, Ayşe Salihoğlu, Ahmet Emre Eşkazan, Bilgül Mete, M. Cem Ar, Şeniz Öngören, Zafer Başlar, Reşat Özaras, Neşe Saltoğlu, Ali Mert, Burhan Ferhanoğlu, Recep Öztürk, Fehmi Tabak, Teoman Soysal; Literature Search: Bilgül Mete, Ayşe Salihoğlu; Writing: Mücahit Yemişen. Conflict <strong>of</strong> Interest: The authors <strong>of</strong> this paper have no conflicts <strong>of</strong> interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included. References 1. 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. 2. Kwon JC, Kim SH, Choi JK, Cho SY, Park YJ, Park SH, Choi SM, Lee DG, Choi JH, Yoo JH. Epidemiology and clinical features <strong>of</strong> bloodstream infections in hematology wards: one year experience at the Catholic Blood and Marrow Transplantation Center. Infect Chemother 2013;45:51-61. 3. Liu CY, Lai YC, Huang LJ, Yang YW, Chen TL, Hsiao LT, Liu JH, Gau JP, Chen PM, Tzeng CH, Chiou TJ. Impact <strong>of</strong> bloodstream infections on outcome and the influence <strong>of</strong> prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients. Bone Marrow Transplant 2011;46:1231-1239. 4. Ali N, Adil SN, Shaikh MU. Bloodstream and central line isolates from hematopoietic stem cell transplant recipients: data from a developing country. Transpl Infect Dis 2014;16:98-105. 5. Gudiol C, Garcia-Vidal C, Arnan M, Sánchez-Ortega I, Patiño B, Duarte R, Carratalà J. Etiology, clinical features and outcomes <strong>of</strong> pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients. Bone Marrow Transplant 2014;49:824-830. 6. Gudiol C, Bodro M, Simonetti A, Tubau F, González-Barca E, Cisnal M, Domingo-Domenech E, Jiménez L, Carratalà J. Changing aetiology, clinical features, antimicrobial resistance, and outcomes <strong>of</strong> bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect 2013;19:474-479. 7. Blennow O, Ljungman P, Sparrelid E, Mattsson J, Remberger M. Incidence, risk factors, and outcome <strong>of</strong> bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations. Transpl Infect Dis 2014;16:106-114. 8. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant 1995;15:825-828. 9. Sullivan KM, Agura E, Anasetti C, Appelbaum F, Badger C, Bearman S, Erickson K, Flowers M, Hansen J, Loughran T, Martin P, Matthews D, Petersdorf E, Radich J, Riddell S, Rovira D, Sanders J, Schuening F, Siadak M, Storb R, Witherspoon RP. Chronic graft-versus-host disease and other late complications <strong>of</strong> bone marrow transplantation. Semin Hematol 1991;28:250-259. 10. Hughes WT, Armstrong D, Bodey GP, Brown AE, Edwards JE, Feld R, Pizzo P, Rolston KV, Shenep JL, Young LS. 1997 guidelines for the use <strong>of</strong> antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society <strong>of</strong> America. Clin Infect Dis 1997;25:551-573. 11. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS. 2002 guidelines for the use <strong>of</strong> antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 2002;34:730-751. 12. Narimatsu H, Matsumura T, Kami M, Miyakoshi S, Kusumi E, Takagi S, Miura Y, Kato D, Inokuchi C, Myojo T, Kishi Y, Murashige N, Yuji K, Masuoka K, Yoneyama A, Wake A, Morinaga S, Kanda Y, Taniguchi S. Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients. Biol Blood Marrow Transplant 2005;11:429-436. 13. Tomlinson D, Mermel LA, Ethier MC, Matlow A, Gillmeister B, Sung L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 2011;53:697-710. 14. Downes KJ, Metlay JP, Bell LM, McGowan KL, Elliott MR, Shah SS. Polymicrobial bloodstream infections among children and adolescents with central venous catheters evaluated in ambulatory care. Clin Infect Dis 2008;46:387-394. 15. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 20th Informational Supplement. CLSI Document M100-S20. Wayne, PA, USA, Clinical and Laboratory Standards Institute, 2010. 16. Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 8th ed. Approved Standard M07-A8. Wayne, PA, USA, Clinical and Laboratory Standards Institute, 2009. 17. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. CLSI Document M100-S22. Wayne, PA, USA, Clinical and Laboratory Standards Institute, 2012. 18. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G,Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrugresistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-281. 221
Change language