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

研究成果: ジャーナルへの寄稿記事

1 引用 (Scopus)

抄録

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.

元の言語英語
ページ(範囲)2302-2309
ページ数8
ジャーナルBiology of Blood and Marrow Transplantation
24
発行部数11
DOI
出版物ステータス出版済み - 11 2018

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Graft vs Host Disease
Hematopoietic Stem Cells
Transplants
Infection
Dysbiosis
Odds Ratio
Confidence Intervals
Morbidity
Bacterial Translocation
Methylprednisolone
Gram-Positive Bacteria
Immunosuppressive Agents
Bacteremia
Gram-Negative Bacteria
Transplant Recipients
Sepsis
Adrenal Cortex Hormones
Fungi
Multivariate Analysis
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

これを引用

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title = "Gastrointestinal Graft-versus-Host Disease Is a Risk Factor for Postengraftment Bloodstream Infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients",
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.",
author = "Yasuo Mori and Goichi Yoshimoto and Ruriko Nishida and Takeshi Sugio and Kohta Miyawaki and Takahiro Shima and Yoji Nagasaki and Noriko Miyake and Yukiko Harada and Yuya Kunisaki and Kenjiro Kamezaki and Akihiko Numata and Koji Kato and Motoaki Shiratsuchi and Takahiro Maeda and Katsuto Takenaka and Hiromi Iwasaki and Nobuyuki Shimono and Koichi Akashi and Toshihiro Miyamoto",
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T1 - Gastrointestinal Graft-versus-Host Disease Is a Risk Factor for Postengraftment Bloodstream Infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients

AU - Mori, Yasuo

AU - Yoshimoto, Goichi

AU - Nishida, Ruriko

AU - Sugio, Takeshi

AU - Miyawaki, Kohta

AU - Shima, Takahiro

AU - Nagasaki, Yoji

AU - Miyake, Noriko

AU - Harada, Yukiko

AU - Kunisaki, Yuya

AU - Kamezaki, Kenjiro

AU - Numata, Akihiko

AU - Kato, Koji

AU - Shiratsuchi, Motoaki

AU - Maeda, Takahiro

AU - Takenaka, Katsuto

AU - Iwasaki, Hiromi

AU - Shimono, Nobuyuki

AU - Akashi, Koichi

AU - Miyamoto, Toshihiro

PY - 2018/11

Y1 - 2018/11

N2 - 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.

AB - 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.

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