Secular trends of Blood stream infections in allogeneic hematopoietic cell transplant recipients 72 hours prior to death

Abstract

Introduction Blood stream infections (BSI) frequently cause morbidity and mortality in allogeneic (allo) hematopoietic cell transplant (HCT) recipients. Characteristics of causative organisms shortly before death have not been previously described. Early treatment with antimicrobial agents targeting the recent surge in multidrug‐resistant (MDR) pathogens may lead to better outcomes. Methods This is retrospective study including 529 allo HCT recipients who died between 2000‐ 2013. All patients who had BSI that happened 72 hours before to death were included. BSI’s and criteria for antimicrobial resistance were defined according to the Centers for Disease Control and Prevention, and the National Healthcare Safety Network surveillance criteria. Results Overall, 104 BSI were identified from 91 patients. Bacterial infections accounted for 87% of the infections which were comprised by 37% gram negative organisms and 50% gram positive bacteria. The most common species were Enterococcus (30%), Staphylococcus (16%), and Pseudomonas (16%). Most enterococci were vancomycin‐resistant (87%) , 100% of Staphylococci were resistant to methicillin, and 64% of Pseudomonas were MDR. Over time there was a significant increase in vancomycin‐resistant Enterococcal (p=0.01) and gram‐negative BSI (p=0.01). Blood stream infections were either the primary or secondary cause of death in 53% of patients. Conclusions In allo HCT recipients, vancomycin‐resistant enterococcal infections caused the majority of BSI 72 hours prior to death. Our findings provide information that may guide empiric antibiotic coverage in critically‐ill HCT recipients.