1102. Infections in Hematopoietic Stem Cell Transplant (HSCT) Recipients: Results from The Organ Transplant Infection Project (OTIP), a Multi-Center, Prospective, Cohort Study
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • OTIP poster 9-30-4.pdf (392.0 kB)
  • Background: 

    Infection (IFX) is a major cause of morbidity and mortality after HSCT. To define better the epidemiology, risk factors and outcomes of infections after HSCT , we conducted a prospective, multicenter cohort study of HSCT recipients from 2006-2011.

    Methods:

    6 US transplant centers followed HSCT recipients for 30 months. Data were prospectively collected.

    Results:

    440 HSCT recipients were enrolled. The median age was 53, and median follow-up 386 (5-1038) days. Most common reasons for HSCT were acute leukemias (46%) and other hematologic malignancies (40%). Conditioning was myeloablative (MA) in 70%. 55% of donors were matched-unrelated (MUD), 39% matched-related  (MRD), and 15% mismatched-unrelated. The overall mortality was 49% (216/440). Death was due to underlying disease in 99 (22%), and IFX in 42 (9%). 102 patients required mechanical ventilation (23%), of whom 85 (83%) died. 379/440 pts (86%) developed IFX; MUD recipients, and those with relapsed malignancy each had OR 3.0 for infection (p=0.03 and <0.001 respectively). Graft versus host disease and steroid use were associated with risk for all infections.

    There were 449 bacterial bloodstream IFX. Most (59%) were gram positive. 132 pts (30%) developed C.difficile colitis. MA recipients (33%) were more likely than non-MA (21%) to develop C. difficile (p=0.015).

    There were 44 (10%) invasive fungal infections (IFI). Most common IFI were Aspergillus pneumonia (n=16) and candidemia (n=6). Other organisms causing IFI included fusarium (n=4), and mucor/rhizopus (n=4). The median time to IFI was 127 days. Mortality was 36/44 (82%) in pts with IFI.

    There were 115 CMV viremias. Only 11 pts (3%) had CMV organ involvement:  6 pneumonias, and 5 gastroenteritis. 12 pts had VZV IFX (3%) with 1 disseminated. Respiratory viral IFX was seen in 42 (9%). 3 had adenovirus, 15 influenza, 12 parainfluenza, and 12 respiratory syncytial virus.

    Conclusion: IFX remains a significant cause of morbidity and mortality after HSCT. Bloodstream infections and C.difficile are frequent. The rate of IFI remains at 10% and is associated with high mortality. Organ involvement with CMV is infrequent, possibly reflecting improved prevention strategies.


    Subject Category: O. Transplant infectious diseases

    Mindy Schuster, MD1, Erik Dubberke, MD, MSPH2, Carol Kauffman, MD3, Robin Avery, MD4, Shaid Husain, MD5, David Paterson, MD6, Fernanda Silveira, MD, MS7, Tom Chiller, MD, MPH8, Angela Ahlquist, MPH8, Debra Wagner, MSPH8, Benjamin Park, MD8 and Peter Pappas, MD9, (1)Infectious Disease, Univ. of Pennsylvania, Philadelphia, PA, (2)Washington University in St. Louis, St. Louis, MO, (3)Univ of Michigan & VA Med Ctr, Ann Arbor, MI, (4)The Cleveland Clinic Foundation, Cleveland, OH, (5)University of Toronto, Toronto, ON, Canada, (6)University of Queensland Centre for Clinical Research, Brisbane, Australia, (7)University of Pittsburgh, Pittsburgh, PA, (8)Centers for Disease Control and Prevention, Atlanta, GA, (9)Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL

    Disclosures:

    M. Schuster, pfizer: Investigator, Research support
    astellas: Investigator, Research support

    E. Dubberke, Merck: Consultant, Consulting fee
    Pfizer: Consultant, Consulting fee
    Steris: Consultant, Consulting fee

    C. Kauffman, merck: Investigator, Research grant
    pfizer: Scientific Advisor, Research support

    R. Avery, roche: Investigator, Research support
    viropharma: Investigator, Research support
    schering-plough: Investigator, Research support
    medimmune: Investigator, Research support

    S. Husain, pfizer: Investigator, Grant recipient
    astellas: Investigator, Grant recipient
    merck: Investigator, Grant recipient

    D. Paterson, None

    F. Silveira, None

    T. Chiller, None

    A. Ahlquist, None

    D. Wagner, None

    B. Park, None

    P. Pappas, merck: Grant Investigator and Scientific Advisor, Grant recipient
    astellas: Investigator and Scientific Advisor, Research support
    pfizer: Investigator and Scientific Advisor, Research grant
    T2 biosystem: Investigator and Scientific Advisor, Research support

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.