Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation

The purpose of this study was to analyse risk factors for blood stream infection (BSI) and pneumonia in neutropenic patients who have undergone peripheral blood stem-cell transplantation (PBSCT). Data were taken from the ONKO-KISS multicenter surveillance project. Infections were identified using CDC definitions (laboratory-confirmed BSI) and modified criteria for pneumonia in neutropenic patients. The multivariate analysis was performed using the Fine–Gray regression model for the cumulative incidences of the competing events ‘infection’, ‘death’ and ‘end of neutropenia’. The risk factors investigated were: sex, age, underlying disease and type of transplant. From January 2000 to June 2004, a total of 1699 patients in 20 hospitals were investigated. In the multivariate analysis, male patients had a significantly higher risk of acquiring BSI than female patients (P=0.002). The risk of acquiring BSI is highest in patients with advanced acute myeloid leukaemia (AML). In the univariate and multivariate analysis, unrelated donor allogeneic transplantation constituted a risk factor for pneumonia (P=0.012). ONKO-KISS provides reference data on the incidence of pneumonia and BSI. The increased risk for BSI in males and patients with advanced AML, and the increased risk for pneumonia in unrelated donor allogeneic PBSCT patients should be targeted to prevent infections in these higher risk groups.

[1]  D. Mannino,et al.  The epidemiology of sepsis in the United States from 1979 through 2000. , 2003, The New England journal of medicine.

[2]  M. Chan-yeung,et al.  Sex differences in tuberculosis in Hong Kong. , 2002, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[3]  C. Dinarello,et al.  Gender differences in IL-1 alpha, IL-1 beta, and IL-1 receptor antagonist secretion from mononuclear cells and urinary excretion. , 1994, Journal of immunology.

[4]  D. Mannino,et al.  The epidemiology of sepsis in patients with malignancy. , 2006, Chest.

[5]  M. Exner,et al.  Surveillance for Nosocomial Infections and Fever of Unknown Origin Among Adult Hematology–Oncology Patients , 2002, Infection Control & Hospital Epidemiology.

[6]  H. Rüden,et al.  Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation , 2003, Bone Marrow Transplantation.

[7]  M. Pasquale,et al.  MALE GENDER IS ASSOCIATED WITH INCREASED RISK FOR POSTINJURY PNEUMONIA , 2004, Shock.

[8]  N Keiding,et al.  Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: Unadjusted analysis , 2001, Bone Marrow Transplantation.

[9]  M. Bauer,et al.  Einfluss des Geschlechts auf die stimulierbare Zytokinantwort bei Patienten mit schwerer Sepsis , 2006, Der Anaesthesist.

[10]  Robert Gray,et al.  A Proportional Hazards Model for the Subdistribution of a Competing Risk , 1999 .

[11]  M. Maris,et al.  Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study. , 2002, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[12]  T. Teräsvirta,et al.  Model selection criteria and model selection tests in regression models , 1986 .

[13]  A A Tsiatis,et al.  Multiple Imputation Methods for Estimating Regression Coefficients in the Competing Risks Model with Missing Cause of Failure , 2001, Biometrics.

[14]  T. Madani.  Clinical Infections and Bloodstream Isolates Associated with Fever in Patients Undergoing Chemotherapy for Acute Myeloid Leukemia , 2000, Infection.

[15]  N. Keiding,et al.  Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part 2: Regression modeling , 2001, Bone Marrow Transplantation.

[16]  Susanne Rosthøj,et al.  Competing risks as a multi-state model , 2002, Statistical methods in medical research.

[17]  W. Huff,et al.  Sex differences in the resistance of turkeys to Escherichia coli challenge after immunosuppression with dexamethasone. , 1999, Poultry science.

[18]  D. Coradini,et al.  Is axillary lymph node dissection necessary in elderly patients with breast carcinoma who have a clinically uninvolved axilla? , 2003, Cancer.

[19]  C. Huber,et al.  Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation , 1997, Bone Marrow Transplantation.

[20]  F. Locatelli,et al.  Incidence of, and Risk Factors for, Nosocomial Infections Among Hematopoietic Stem Cell Transplantation Recipients, With Impact on Procedure-Related Mortality , 2001, Infection Control & Hospital Epidemiology.

[21]  G. Opelz,et al.  Strong inflammatory cytokine response in male and strong anti-inflammatory response in female kidney transplant recipients with urinary tract infection. , 2004, Transplant international : official journal of the European Society for Organ Transplantation.

[22]  P. Wiernik,et al.  Nosocomial Infections in Neutropenic Cancer Patients , 1993, Infection Control & Hospital Epidemiology.

[23]  H. Rüden,et al.  Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  H. Davies,et al.  Population-based study of the epidemiology of and the risk factors for invasive Staphylococcus aureus infections. , 2003, The Journal of infectious diseases.

[25]  M. Silomon,et al.  [Influence of gender on stimulated cytokine response in patients with severe sepsis]. , 2006, Der Anaesthesist.

[26]  E. Estey,et al.  Systemic antifungal prophylaxis reduces invasive fungal infections in acute myelogenous leukemia , 2002 .