1127. Bone and Joint Infections among Hematopoietic Stem cell transplant (HSCT) Recipients 
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Bone and Joint Final ppt .pdf (888.8 kB)
  • Background:

     

    Bone and joint infections (BJI) among HSCT recipients are not well described.

     

    Methods:

    We retrospectively reviewed 5,861 patients who underwent HSCT at Mayo Clinic, Rochester from 1/1/2005 through 1/1/2015. Using a computerized search engine, we identified 107 patients with potential BJI and reviewed their electronic medical record. All adults who developed BJI after HSCT were included in the analysis. Kaplan Meier estimate was used to evaluate time to event.

    Results:

    Of 5861 patients, 34 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/34 (44%) patients (Figure 1).

    Patients were predominantly male (25/34, 74%) and the median patient age was 58 years old (range 20-72). An underlying lymphoid (25/34, 74%) or myeloid (9/34, 27%) malignancy was the reason for HSCT.  BJI was diagnosed a median of 41 (range 1-129) months after allogeneic (14/34, 41%) or autologous (20/34, 59%) HSCT. Organisms were recovered via tissue (31/34, 91%), synovial fluid (13/17, 77%), and blood cultures (17/26, 65%). Gram positive pathogens were the most frequently isolated (25/31, 81%). All patients were given induction antimicrobial therapy; most underwent concomitant surgical debridement (23/34, 68%). Eight patients (23.5%) were subsequently placed on suppressive therapy. Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 5/34 (14.7%), with the cause of death related to the underlying BJI in two (40%). Failure occurred a median of 0.4 (0.1-48.5) months from diagnosis. At last follow up, 7/34 (21%) patients were alive, of whom 6 were treated successfully. Median overall survival was 12.9 months (3.7-26).

    Conclusion:

    BJI among HSCT recipients is infrequent; when it occurs, the most common infection is native joint septic arthritis. Pathogens appear similar to those for patients without HSCT. Treatment involving combination surgical-medical modalities is successful for the majority, with most patients surviving >1 year after BJI.

     


    Total patents
(N= 5861)
,ICD-9 search (n=75), Text search (n=31)
,Pathology search (n =10), Possible BJI (n=107),Excluded (n=73)
, Septic Arthritis (n=15),Vertebral osteomyelitis (n=4)
,Appendicular osteomyelitis (n =6),Prosthetic Joint Infections
(n=6)
,BJI (n=34)
,Other*
(n=3)
, Hardware removed (n=3),Hardware retained (n=3),I&D
(n=9)
, I&D
(n =4)
I &D
,Hardware retained (n=1), Hardware removed(n=1),SURGERY PERFORMED,Failure (n=1),Failure (n=2),Failure (n=1), Failure (n=1),Reason for exclusion (n):
No BJI (48)
Infection prior to transplant (18)
Other BJI (e.g. head/neck) (7)
,NO SURGERY PERFORMED

     

     

     

     

     

     

     

     

     

    Figure 1: Flowchart of the Transplant study cohort   HSCT = Hematopoietic stem cell transplant BJI = Bone and Joint Infection

    *Other – Necrotizing fasciitis, Hardware infection

    Cybele Lara Abad, MD1, Vania Phuoc, MD2, Prashant Kapoor, MD3, Aaron Tande, MD1, Irene Sia, MD1, Pritish K. Tosh, MD1 and D Osmon, MD1, (1)Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (2)Department of Internal Medicine, Mayo Clinic, Rochester, MN, (3)Department of Hematology, Mayo Clinic, Rochester, MN

    Disclosures:

    C. L. Abad, None

    V. Phuoc, None

    P. Kapoor, None

    A. Tande, None

    I. Sia, None

    P. K. Tosh, None

    D. Osmon, None

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