Abstract
Objective:Patients receiving hematopoietic stem cell transplantation (HSCT) are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs) are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively.Materials and Methods:The epidemiological properties of 312 patients with HSCT were retrospectively evaluated.Results:A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62%) and allogeneic (38%) HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28%) and Hodgkin lymphoma (21.5%). A total of 142 (45%) patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011), and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2%) and Acinetobacter baumannii (8.8%) were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively.Conclusion:A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.
Highlights
Bloodstream infection (BSI) is the most common infectious problem in patients undergoing hematopoietic stem cell transplantations (HSCTs)
A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs
Depending on the protocol used for transplantation and the duration of neutropenia, approximately 13%-60% of patients develop BSIs, which can result in delays in chemotherapies, extension of admission period, and increased costs of antimicrobial therapy against target organisms [1,2]
Summary
Bloodstream infection (BSI) is the most common infectious problem in patients undergoing hematopoietic stem cell transplantations (HSCTs). While gram-negative BSIs among neutropenic cancer patients were formerly the leading cause of bacteremia, the etiology of BSIs in this patient population has become predominantly gram-positive, and especially viridans group streptococci and coagulase-negative staphylococci, over the last 2 decades [5,6]. Besides this shift, resistance rates and patterns started to change and more resistant microorganisms are found as the causes of BSIs. For example, the emergence of fluoroquinolone-resistant bacteria, increase in multidrugresistant gram-negative bacteria, increase in nosocomial methicillin-resistant Staphylococcus aureus infections, and emergence of extended-spectrum beta-lactamase (ESBL) producers have all been reported in the literature in neutropenic patients [3]. We evaluate the risk factors, resistance patterns, and sources of BSIs in this group of patients as a secondary objective
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