Pre-engraftment bacteremia after allogeneic hematopoietic cell transplantation without primary fluoroquinolone antibacterial prophylaxis

Article Article scientifique Article Pre-engraftment bacteremia after allogeneic hematopoietic cell transplantation without primary fluoroquinolone antibacterial prophylaxis eng 2024-09-23 author Nguyen Aude Thuy-Tien 0000-0002-9640-5146 Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 974623 author Fender Jordan Department of Internal Medicine, Rehabilitation and Geriatrics, Internal Medicine and Rehabilitation Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. 850892 author Courjon Johan Infectious Diseases Unit, University Côte d'Azur, CHU Nice, Nice, France. author Fischer Adrien Bacteriology Laboratory, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland. 403596 author Mappoura Maria Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 863815 author Morin Sarah Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 935831 author Giannotti Federica Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 918560 author Mamez Anne-Claire Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 918000 author Chalandon Yves Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 644957 Département de médecine (DEMED) author Masouridi Levrat Stavroula Hematology Division, Department of Oncology, University Hospital of Geneva, and Faculty of Medicine, Geneva, Switzerland. 844685 Département de médecine (DEMED) author Neofytos Dionysios Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland. 911674 Département de médecine (DEMED) e14375 10.1111/tid.14375 39312267 1398-2273 https://onlinelibrary.wiley.com/doi/10.1111/tid.14375 Background: Bacteremia is a common complication in allogeneic hematopoietic cell transplant recipients (alloHCTr), especially during the pre-engraftment period. International guidelines recommend antibacterial prophylaxis (ABP), despite potential selection for multidrug-resistant organisms (MDRO). Limited contemporary data exist on the epidemiology of pre-engraftment bacteremia in alloHCTr, who do not receive ABP. Methods: We performed a retrospective observational single-center cohort study including all consecutive adult alloHCTr (2015-2021), investigating the incidence, risk factors, and outcomes of bacteremia during the engraftment period. Primary fluoroquinolone (FQ) ABP is not routinely administered in our center. Results: Among 421 patients identified, 124 bacteremia episodes were observed in 121/421 (29%) alloHCTr. The median time to the 1st bacteremia episode was 9 days (IQR 6-11). Most (105/124, 85%) episodes were monomicrobial, while >1 pathogens were identified in 19/124 (15%) episodes. Overall, 152 pathogens were isolated, with a predominance of Gram-positive (118/152, 78%), including coagulase-negative staphylococci (n:47), streptococci (n:46), and enterococci (n:15), followed by Gram-negative bacteria (GNB, 30/152, 20%), and anaerobes (4/152, 3%). There were 2/152 (1%) MDRO (extended-spectrum beta-lactamase producing) GNB. Multivariable analyses identified age >40-year-old (OR 2.4, P = 0.02), male gender (OR 1.8, P = 0.02), and a haploidentical/mismatched unrelated donor (OR 2.5, P < 0.001) as independent risk factors for bacteremia. All cause 30-day mortality among alloHCTr with bacteremia was 0.8% (1/121): one patient died due to an HCT-related complication. Conclusion: Despite lack of primary FQ ABP, low rates of bacteremia were observed during the pre-engraftment period, with low MDRO prevalence and mortality. Our findings may allow to revisit the need for primary universal FQ ABP in high-risk neutropenic hematology patients. Allogeneic hematopoietic stem cell transplantation Antibacterial prophylaxis Antibiotics Bacteremia Bloodstream infection Engraftment period Dewey 616 56 Département de médecine 221 false 526 Résistance aux antibiotiques 866 1216 Leucémie et transplantation allogénique de cellules souches hématopoïétiques 982 Transplant infectious disease fbf5ff26-16c1-46d7-ac98-db010a0aca69 Article (Published version) Public file.pdf 540096 application/pdf CC BY-NC-ND-4.0 30830178f2e76ddda2c2dfe25b15fb421d64701cbb867cc0ac5979f4c9a74e0e openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Pre-engraftment bacteremia after allogeneic hematopoietic cell transplantation without primary fluoroquinolone antibacterial prophylaxis	Transplant infectious disease			2024	67	183

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Fender, Jordan