Clinical Analysis Of Bloodstream Infection In Patients With Allogeneic Hematopoietic Stem Cell Transplantation

Objective: To describe epidemiology,clinical characteristicsand outcome of bloodstream infection inpatients undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT)in our hospital,subsequently provide clinical evidence for appropriate use of antibiotics and improve survivalof transplant recipients with bloodstream infection.Method: A retrospective review was conducted in 210 patients who received allo-HSCT between October 2014 and September 2019 from Department of Hematology in our hospital.Etiology,pathogen spectrum,antibiotic resistance,infectionrisk factors and outcomes were analyzed in 49 documented allo-HSCT recipients with bloodstream infection confirmed by blood culture.Results: Of 210 allo-HSCT patients,bloodstream infection was identified in 49 patients with an incidence rate of 23.3%.Epidemiologic analysis showed that 59 strains of pathogens were isolated.They were Gram-negative bacteria 40 strains(67.8%)with 17 ones(42.5%)of Carbapenem-resistant organisms(CRO),Gram-positive bacteria 14(23.7%)without staphylococci resistant to vancomycinor linezolid and fungi 5 ones(8.5%).In the univariate analysis,the potential risk factors for bloodstream infection included disease status of the patient pre-transplantationand intensity of conditioning regimen.In the multivariate analysis showed that bloodstream infection was mainly related to intensity of conditioning regimen.77.6%bloodstream infection occurred in patients with neutropenia while 22.4% did in patients without neutropenia.81.0% patients with active infection before transplantation developed bloodstream infection while only 16.9% of patients without infection had bloodstream infection.Survival analysis showed that long-term survivalof patients with bloodstream infection was shorter than that of patients without bloodstream infection;the survival of patients with CRO infection was shorter than that of patients without CRO infection.Those patients with a duration of neutropenia longer than 14 days had a shorter survival than patients with neutropenialess than 14 days.However,neither active infection pre-transplantation norbloodstream infection occurring during neutropenia had statistical correlation with survival.Conclusion: Our findings suggested bloodstream infection significantly affected survival of allo-HSCT recipients.Prevention of bloodstream infections,particularly from CRO,shortening the duration of neutropenia,control of active infections pre-transplantation,and appropriate intensity of conditioning regimen could reduce transplant-related mortality and improve patients’ prognosis.