Secular Trends of Bloodstream Infections during Neutropenia in 15,181 Haematopoietic Stem Cell Transplants: 13-year Results from a European Multicentre Surveillance Study (ONKO-KISS).
Clin Microbiol Infect. 2017 Mar 30;:
Authors: Weisser M, Theilacker C, Sutter ST, Babikir R, Bertz H, Götting T, Dettenkofer M, Kern WV, Widmer AF, Hospital Infection Surveillance System for Patients with Haematologic/Oncologic Malignancies Study Group (ONKO-KISS)
OBJECTIVES: Antibacterial resistance is emerging in patients undergoing haematopoietic stem cell transplantation (HSCT) and most data on the epidemiology of bloodstream infections (BSI)-causing pathogens come from retrospective, single-centre studies. Aim of this study is to investigate trends in the epidemiology of BSI in HSCT recipients from a prospective multicentre cohort.
METHODS: From 2002 to 2014 we investigated changes in the incidence of causative organisms of BSI during neutropenia among adult HSCT recipients. The data were collected from a prospective cohort for infection surveillance in 20 haematologic cancer centres in Germany, Austria and Switzerland (ONKO-KISS).
RESULTS: 2,388 out of 15,181 HSCT recipients with neutropenia (1471 allogeneic [61.6%] and 917 autologous [38.4%]) developed BSIs (incidence 15.8%/year). The incidence of Gram-negative BSIs increased over time both in patients after allogeneic HSCT (allo-HSCT) and autologous HSCT (auto-HSCT). BSIs caused by Escherichia coli in allo-HSCT patients increased from 1.1% in 2002 to 3.8% in 2014 (3/279 vs. 31/810 patients, p<0.001) and the incidence of BSIs caused by enterococci increased from 1.8% to 3.3% (5 vs. 27 patients, p<0.001). In contrast, the incidence of BSIs due to coagulase-negative staphylococci decreased in allo-HSCT patients from 8.2% to 5.13%, (23 vs. 40 patients, p<0.001) and in auto-HSCT patients from 7.7% to 2.0% (13/167 vs. 30/540 patients (p=0.028 period 2002-2011 only). No significant trends were observed for the incidence of BSI due to methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) or extended spectrum β-lactamase-(ESBL)-producing Enterobacteriaceae. The BSI case fatality remained unchanged over the study period (total of 477 fatalities, 3.1%).
CONCLUSIONS: The incidence of Gram-negative BSIs significantly increased over time in this vulnerable patient population providing evidence for re-evaluating empiric therapy for neutropenic fever in HSCT patients.
PMID: 28366613 [PubMed - as supplied by publisher]