Microbiological profile in patients with multiple myeloma who developed febrile neutropenia during autologous hematopoietic stem cell transplantation

Perfil microbiológico en pacientes con mieloma múltiple que presentaron neutropenia febril durante trasplante autólogo de precursores hematopoyéticos: descripción de una serie de casos

Published 2023-08-03

Open | Download
PDF (Spanish) FLIP
Issue
Vol. 10 No. 1 (2023): Enero-junio
Section
Original articles
How to Cite
Microbiological profile in patients with multiple myeloma who developed febrile neutropenia during autologous hematopoietic stem cell transplantation .
Rev. colomb. hematol. oncol. [Internet]. 2023 Aug. 3 [cited 2024 Dec. 22];10(1):10-26. Disponible en: https://doi.org/10.51643/22562915.500
DOI

https://doi.org/10.51643/22562915.500
Dimensions
PlumX
license
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Guillermo Andrés Herrera Rueda
Instituto de Cancerología Las Américas AUNA. Medellín, Colombia.
    https://orcid.org/0000-0002-0701-7441
    Deisy Johana Herrera Blandón
    Instituto de Cancerología Las Américas AUNA. Medellín, Colombia.
      Kevin Saldarriaga Bedoya
      Universidad de Antioquia. Medellín, Colombia.
        https://orcid.org/0000-0001-7331-1131
        Angélica Cardona Molina
        Fundación Ideas AUNA. Medellín, Colombia.
          https://orcid.org/0000-0003-0802-3533
          Amado José Karduss Ureta
          Instituto de Cancerología Las Américas AUNA. Medellín, Colombia.
            Show authors biography

            Guillermo Andrés Herrera Rueda ,

            Médico Internista, Universidad Industrial de Santander y Médico Hematólogo, Universidad de Antioquia.

            Deisy Johana Herrera Blandón,

            Médica General, Universidad de Antioquia.

            Kevin Saldarriaga Bedoya,

            Médico en formación, Universidad de Antioquia.

            Angélica Cardona Molina,

            Gerente de Sistemas de información en salud.

            Amado José Karduss Ureta,

            Médico Hematólogo.

            Transplant units must understand their epidemiological profile to adjust the antibiotic protocol in febrile neutropenic. Objective: Describe microbiological outcomes related to the febrile neutropenia events of a multiple myeloma patients cohort during the hospitalization for autologous hematopoietic stem cell transplantation. Methods: A descriptive analysis was made from retrospective data of 62 patients with multiple myeloma who presented febrile neutropenia when hospitalized for autologous hematopoietic stem cell transplantation between 01 January 2020 and June 2021. A description of the source of infection and the isolated microorganism was presented. Results: 50% of the patients had a documented or defined source of infection, of which 70.9% were made from positive microbiologic tests and the rest from clinical criteria. Of those identified from the laboratory, bacteremia was the principal documented source (19/62), followed by gastroenterocolitis (9/31). From the isolated agents in blood cultures, the most frequent was S. epidermidis (14/19). Conclusions: Half of the patients with febrile neutropenia had a documented infection, most of them bacteremia due to coagulase-negative Gram-positive cocci, with a low prevalence of Gram-negative bacteria and fungus, independently of the subtype of isolation, there was a low prevalence of adverse outcomes in the cohort.

            Article visits 485 | PDF visits 432

            1. Aggarwal M, Agrawal N, Yadav N. et al. Autologous stem cell transplantation in first remission is associated with better progression-free survival in multiple myeloma. Ann Hematol [Internet]. 2018;97:1869-1877. Disponible en: https://doi.org/10.1007/s00277-018-3370-1
            2. Marini C, Maia T, Bergantim R. et al. Datos de la vida real sobre la seguridad y la eficacia del trasplante autólogo de células madre en pacientes de edad avanzada con mieloma múltiple. Ann Hematol [Internet]. 2019;98:369-379. Disponible en: https://doi.org/10.1007/s00277-018-3528-x
            3. Jantunen E, Itälä M, Lehtinen T, Kuittinen O, Koivunen E, Leppä S, Juvonen E, Koistinen P, Wiklund T, Nousiainen T, Remes K, & Volin L. Early treatment-related mortality in adult autologous stem cell transplant recipients: a nation-wide survey of 1482 transplanted patients. European Journal of Haematology [Internet]. 2006;76(3):245–250. Disponible en: https://doi.org/10.1111/j.1600-0609.2005.00605.x
            4. Sexton ME, Langston AA, Wiley Z. et al. Administración antimicrobiana en la población de trasplante de células madre hematopoyéticas. Curr Treat Options Infect Dis [Internet]. 2018;10:249–262. Disponible en: https://doi.org/10.1007/s40506-018-0159-7
            5. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston, KV, Young JA, Wingard JR, & Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America [Internet]. 2011;52(4):e56–e93. Disponible en: https://doi.org/10.1093/cid/cir073
            6. Groll AH, Castagnola E, Cesaro S, Dalle JH, Engelhard D, Hope W, Roilides E, Styczynski J, Warris A, Lehrnbecher T. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. The Lancet. Oncology [Internet]. 2014;15(8):e327–e340. Disponible en: https://doi.org/10.1016/S1470-2045(14)70017-8
            7. Santos KB, Hallack Neto AE, Silva GA, Atalla A, Abreu MM, Ribeiro LC. Infection profile of patients undergoing autologous bone marrow transplantation in a Brazilian institution. Sao Paulo Med J [Internet]. 2012;130(1):10–6. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802012000100003&lng=en&tlng=en
            8. Gil L, Styczynski J, Komarnicki M. Infectious Complication in 314 Patients after High-Dose Therapy and Autologous Hematopoietic Stem Cell Transplantation: Risk Factors Analysis and Outcome. Infection [Internet]. 2007 Dec 9;35(6):421–7. Disponible en: http://link.springer.com/10.1007/s15010-007-6350-2
            9. Gassas RS, Absi AN, Alghamdi AA, Alsaeed AS, Alamoudi SM, Hemaidi IY, et al. Early infection in post-autologous hematopoietic stem cell transplant patients. Saudi Med J [Internet]. 2021 Aug 2;42(8):847–52. Disponible en: https://smj.org.sa/lookup/doi/10.15537/smj.2021.42.8.20210236
            10. Bow EJ. Neutropenic Fever Syndromes in Patients Undergoing Cytotoxic Therapy for Acute Leukemia and Myelodysplastic Syndromes. Semin Hematol [Internet]. 2009 Jul;46(3):259–68. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0037196309000572
            11. Piñana JL, Montesinos P, Martino R, Vazquez L, Rovira M, López J, et al. Incidence, risk factors, and outcome of bacteremia following autologous hematopoietic stem cell transplantation in 720 adult patients. Ann Hematol [Internet]. 2014 Feb 1;93(2):299–307. Disponible en: http://link.springer.com/10.1007/s00277-013-1872-4
            12. Mohan M, Susanibar‐Adaniya S, Buros A, Crescencio JCR, Burgess MJ, Lusardi K, et al. Bacteremias following autologous stem cell transplantation for multiple myeloma: Risk factors and outcomes. Transpl Infect Dis [Internet]. 2019 Apr 15;21(2):e13052. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/tid.13052
            13. Meyer E, Beyersmann J, Bertz H, Wenzler-Röttele S, Babikir R, Schumacher M, et al. Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant [Internet]. 2007 Feb 24;39(3):173–8. Disponible en: https://www.nature.com/articles/1705561
            14. Dettenkofer M, Wenzler‐Rottele S, Babikir R, Bertz H, Ebner W, Meyer E, et al. Surveillance of Nosocomial Sepsis and Pneumonia in Patients with a Bone Marrow or Peripheral Blood Stem Cell Transplant: A Multicenter Project. Clin Infect Dis [Internet]. 2005 Apr;40(7):926–31. Disponible en: https://academic.oup.com/cid/article-lookup/doi/10.1086/428046
            15. Viscoli C, Varnier O, Machetti M. Infections in Patients with Febrile Neutropenia: Epidemiology, Microbiology, and Risk Stratification. Clin Infect Dis [Internet]. 2005 Apr 1;40(Supplement_4):S240–5. Disponible en: http://academic.oup.com/cid/article/40/Supplement_4/S240/437116/Infections-in-Patients-with-Febrile-Neutropenia
            16. De la Rubia J, Montesinos P, Martino R, Jarque I, Rovira M, Vázquez L, et al. Imipenem/Cilastatin with or without Glycopeptide as Initial Antibiotic Therapy for Recipients of Autologous Stem Cell Transplantation: Results of a Spanish Multicenter Study. Biol Blood Marrow Transplant [Internet]. 2009 Apr;15(4):512–6. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1083879108011373
            17. Ninin E, Milpied N, Moreau P, André‐Richet B, Morineau N, Mahé B, et al. Longitudinal Study of Bacterial, Viral, and Fungal Infections in Adult Recipients of Bone Marrow Transplants. Clin Infect Dis [Internet]. 2001 Jul;33(1):41–7. Disponible en: https://academic.oup.com/cid/article-lookup/doi/10.1086/320871
            18. Laws HJ, Kobbe G, Dilloo D, Dettenkofer M, Meisel R, Geisel R, et al. Surveillance of nosocomial infections in paediatric recipients of bone marrow or peripheral blood stem cell transplantation during neutropenia, compared with adult recipients. J Hosp Infect [Internet]. 2006 Jan;62(1):80–8. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0195670105002112
            19. Çelebi H, Akan H, Akçağlayan E, Üstün C, Arat M. Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies. Bone Marrow Transplant [Internet]. 2000 Jul 1;26(2):211–4. Disponible en: https://www.nature.com/articles/1702503
            20. Kanamaru A, Tatsumi Y. Microbiological Data for Patients with Febrile Neutropenia. Clin Infect Dis [Internet]. 2004 Jul 15;39(s1):S7–10. Disponible en: https://academic.oup.com/cid/article-lookup/doi/10.1086/383042
            21. Koya R, Andersen J, Fernandez H, Goodman M, Spector N, Smith R, et al. Analysis of the value of empiric vancomycin administration in febrile neutropenia occurring after autologous peripheral blood stem cell transplants. Bone Marrow Transplant [Internet]. 1998 May 1;21(9):923–6. Disponible en: https://www.nature.com/articles/1701201
            22. Vardakas KZ, Samonis G, Chrysanthopoulou SA, Bliziotis IA, Falagas ME. Role of glycopeptides as part of initial empirical treatment of febrile neutropenic patients: a meta-analysis of randomised controlled trials. Lancet Infect Dis [Internet]. 2005 Jul;5(7):431–9. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S147330990570164X
            23. Joncour A, Puyade M, Michaud A, Tourani J-M, Cazenave-Roblot F, Rammaert B. Is current initial empirical antibiotherapy appropriate to treat bloodstream infections in short-duration chemo-induced febrile neutropenia? Support Care Cancer [Internet]. 2020 Jul 31;28(7):3103–11. Disponible en: http://link.springer.com/10.1007/s00520-019-05113-4
            24. Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, et al. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies. Clin Microbiol Infect [Internet]. 2019 Apr;25(4):447–53. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1198743X18305445
            25. Lamy B. Blood culture time-to-positivity: making use of the hidden information. Clin Microbiol Infect [Internet]. 2019 Mar;25(3):268–71. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1198743X18307730
            26. Meletis G. Carbapenem resistance: overview of the problem and future perspectives. Ther Adv Infect Dis [Internet]. 2016 Feb 10;3(1):15–21. Disponible en: http://journals.sagepub.com/doi/10.1177/2049936115621709
            27. Alshukairi A, Alserehi H, El-Saed A, Kelta M, Rehman JU, Khan FA, et al. A de-escalation protocol for febrile neutropenia cases and its impact on carbapenem resistance: A retrospective, quasi-experimental single-center study. J Infect Public Health [Internet]. 2016 Jul;9(4):443–51. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1876034115002063
            28. Marin M, Gudiol C, Ardanuy C, Garcia-Vidal C, Calvo M, Arnan M, et al. Bloodstream infections in neutropenic patients with cancer: Differences between patients with haematological malignancies and solid tumours. J Infect [Internet]. 2014 Nov;69(5):417–23. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0163445314001716
            29. Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica [Internet]. 2013 Dec 1;98(12):1826–35. Disponible en: http://www.haematologica.org/cgi/doi/10.3324/haematol.2013.091025
            30. Verlinden A, Jansens H, Goossens H, Anguille S, Berneman ZN, Schroyens WA, et al. Safety and Efficacy of Antibiotic De-escalation and Discontinuation in High-Risk Hematological Patients With Febrile Neutropenia: A Single-Center Experience. Open Forum Infect Dis [Internet]. 2022 Mar 1;9(3). Disponible en: https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofab624/6481743
            31. Alonso CD, Dufresne SF, Hanna DB, Labbé A-C, Treadway SB, Neofytos D, et al. Clostridium difficile Infection after Adult Autologous Stem Cell Transplantation: A Multicenter Study of Epidemiology and Risk Factors. Biol Blood Marrow Transplant [Internet]. 2013 Oct;19(10):1502–8. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S1083879113003443
            32. Huang AM, Marini BL, Frame D, Aronoff DM, Nagel JL. Risk factors for recurrent Clostridium difficile infection in hematopoietic stem cell transplant recipients. Transpl Infect Dis [Internet]. 2014 Oct;16(5):744–50. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/tid.12267
            33. Wang S. Timing of Blood Cultures in the Setting of Febrile Neutropenia: An Australian Institutional Experience. Turkish J Hematol [Internet]. 2021 Feb 25;38(1):57–63. Disponible en: https://jag.journalagent.com/z4/download_fulltext.asp?pdir=tjh&plng=eng&un=TJH-28044
            34. Bow EJ. Neutropenic Fever Syndromes in Patients Undergoing Cytotoxic Therapy for Acute Leukemia and Myelodysplastic Syndromes. Semin Hematol [Internet]. 2009 Jul;46(3):259–68. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0037196309000572
            35. Klumpp TR, Mangan KF, Goldberg SL, Pearlman ES, Macdonald JS. Granulocyte colony-stimulating factor accelerates neutrophil engraftment following peripheral-blood stem-cell transplantation: a prospective, randomized trial. J Clin Oncol [Internet]. 1995 Jun;13(6):1323–7. Disponible en: https://ascopubs.org/doi/10.1200/JCO.1995.13.6.1323
            36. Offidani M, Corvatta L, Olivieri A, Rupoli S, Frayfer J, Mele A, et al. Infectious complications after autologous peripheral blood progenitor cell transplantation followed by G-CSF. Bone Marrow Transplant [Internet]. 1999 Nov 1;24(10):1079–87. Disponible en: https://www.nature.com/articles/1702033
            37. Bates DW. Contaminant Blood Cultures and Resource Utilization. JAMA [Internet]. 1991 Jan 16;265(3):365. Disponible en: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1991.03460030071031

            Information

            Directories and indexers
            Google Scholar profile

            QR code

            Keywords

            Most read in the last 30 days

            Current Issue

            Sistema OJS 3.4.0.7 - Metabiblioteca |