1105. Trends in Early Bloodstream Infections in Patients Undergoing Hematopoietic Allogeneic Stem Cell Transplantation
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Bloodstream infections (BSIs) have remained as one of the most frequent complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the peri-transplant period (i.e. before the day 35). At our institution, transplantation practices have changed over the last decade, including more umbilical cord transplants, changes in conditioning chemotherapy regimens, and alterations in antibiotic prophylaxis strategies. In this setting of evolving transplantation practices, we sought to characterize the corresponding trends in early BSIs seen in these patients.

Methods: We collected observational data from adult patients who underwent allo-HSCT at Memorial Sloan-Kettering Cancer Center from 1999 to 2010. Collected data included whether the patient sustained a BSI prior to post-transplant day +35, age, sex, race, and allo-HSCT characteristics such as transplant type and conditioning regimen. Bloodstream infections with coagulase-negative Staphylococci were not included for analysis. Overall changes in BSI characteristics (and other outcomes such as overall mortality) were analyzed by logistic regression. 

Results: During our study period, there were 964 adult patients who underwent allo-HSCT at our institution. Of these patients, 176 (18.3%) developed early BSI. A striking majority of these infections occurred within a small time interval: 95% of early BSIs occurred between post-transplant day -1 and +10. Vancomycin-resistant Enterococcus (VRE) increased in prevalence as a cause of BSI, from 0% during 1999-2002, to 50-60% during 2008-2010 (overall test of trend, P=0.000). Similarly, gram-negative BSIs increased from 20-25% during 1999-2000, to 30-70% during 2009-2010 (P=0.001). On the other hand, BSIs with Streptococcus viridans decreased from as high as 80% in 1999 to 0% during 2009-2010 (P=0.000). Overall mortality decreased over the course of the decade (OR per year: 0.89, P=0.00), and a clear, persistent correlation with early BSI was observed (OR: 1.51, P=0.013).

Conclusion: We conclude that the character of early BSIs has changed drastically over the last decade at our institution. We attribute these changes to our evolving transplantation practices.


Subject Category: O. Transplant infectious diseases

Ying Taur, MD, MPH1, Dick Chung, BS1, Lalitha Parameswaran, MD, MPH2, Yeon Joo Lee, MD, MPH1, Ann Jakubowski, MD, PhD2, Susan Seo, MD2 and Genovefa Papanicolaou, MD1, (1)Infectious Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY, (2)Memorial Sloan-Kettering Cancer Center, New York, NY

Disclosures:

Y. Taur, None

D. Chung, None

L. Parameswaran, None

Y. J. Lee, None

A. Jakubowski, None

S. Seo, None

G. Papanicolaou, Pfizer: Grant Investigator, Research grant

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