Perfil microbiológico en pacientes con mieloma múltiple que presentaron neutropenia febril durante trasplante autólogo de precursores hematopoyéticos: descripción de una serie de casos
Microbiological profile in patients with multiple myeloma who developed febrile neutropenia during autologous hematopoietic stem cell transplantation
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Las unidades de trasplante de precursores hematopoyéticos deben conocer su perfil epidemiológico con el fin de ajustar los protocolos de antibiótico en neutropenia febril. Objetivo: describir los aislamientos microbiológicos relacionados con los eventos de neutropenia febril de una serie de casos de pacientes con mieloma múltiple durante la hospitalización por trasplante autólogo de precursores hematopoyéticos. Métodos: se realizó un análisis descriptivo de datos retrospectivos de una serie de 62 pacientes con neutropenia febril, hospitalizados por trasplante autólogo de precursores hematopoyéticos durante el periodo comprendido entre el 1° de enero del 2020 y junio del 2021. Resultados: el 50 % de los pacientes tuvo un foco infeccioso documentado, de los cuales el 70.9 % fue por prueba microbiológica positiva y el restante por razón clínica. De aquellos identificados por laboratorio, la bacteriemia fue el principal foco (19/62), seguida por la gastroenterocolitis (9/31). De los microorganismos aislados en hemocultivo el más frecuente fue S. epidermidis (14/19). Conclusiones: la mitad de los pacientes con neutropenia febril presentaron foco infeccioso documentado, la mayor parte bacteriemia por cocos Gram positivos coagulasa negativa, con baja prevalencia de gérmenes Gram negativos y de hongos. Independiente del subtipo de aislamiento hubo una baja prevalencia de desenlaces adversos en este grupo de pacientes.
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
