Gastrointestinal Graft-versus-Host Disease Is a Risk Factor for Postengraftment Bloodstream Infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Yasuo Mori, Goichi Yoshimoto, Ruriko Nishida, Takeshi Sugio, Kohta Miyawaki, Takahiro Shima, Yoji Nagasaki, Noriko Miyake, Yukiko Harada, Yuya Kunisaki, Kenjiro Kamezaki, Akihiko Numata, Koji Kato, Motoaki Shiratsuchi, Takahiro Maeda, Katsuto Takenaka, Hiromi Iwasaki, Nobuyuki Shimono, Koichi Akashi, Toshihiro Miyamoto

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Abstract

Bloodstream infection (BSI) is a well-known cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Here, we conducted a retrospective study to assess the morbidity, etiology, risk factors, and outcomes of BSI in the postengraftment period (PE-BSI) after allo-HSCT. Forty-three of 316 patients (13.6%) developed 57 PE-BSI episodes, in which 62 pathogens were isolated: Gram-positive bacteria, gram-negative bacteria, and fungi, respectively, accounted for 54.8%, 35.5%, and 9.7% of the isolates. Multivariate analysis revealed methylprednisolone use for graft-versus-host disease (GVHD) prophylaxis (odds ratio [OR], 6.49; 95% confidence interval [CI], 1.49 to 28.2; P =.013) and acute gastrointestinal GVHD (GI-GVHD) (OR, 8.82; 95% CI, 3.99 to 19.5; P <.0001) as risk factors for developing PE-BSI. This finding suggested that GI-GVHD increases the risk of bacterial translocation and subsequent septicemia. Moreover, among patients with GI-GVHD, insufficient response to corticosteroids, presumably related to an intestinal dysbiosis, significantly correlated with this complication. Patients with PE-BSI presented worse outcome compared with those without (3-year overall survival, 47.0% versus 18.6%; P <.001). Close microbiologic monitoring for BSIs and minimizing intestinal dysbiosis may be crucial to break the vicious cycle between GI-GVHD and bacteremia and to improve transplant outcomes especially in patients who require additional immunosuppressants.

Original languageEnglish
Pages (from-to)2302-2309
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number11
DOIs
Publication statusPublished - Nov 2018

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All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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