Infections in hematopoietic cell transplant recipients: Results from the organ transplant infection project, a multicenter, prospective, cohort study

Mindy G. Schuster, Angela A. Cleveland, Erik R. Dubberke, Carol A. Kauffman, Robin Avery, Shahid Husain, David L. Paterson, Fernanda P. Silveira, Tom M. Chiller, Kaitlin Benedict, Kathleen Murphy, Peter G. Pappas

Research output: Contribution to journalArticle

Abstract

Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87%). The overall crude mortality was 52%. Death was due to underlying disease in 44% cases and infection in 21%. Bacteremia occurred in 231 (52%) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45% vs 13%, P = .02). Clostridium difficile infection developed in 148 patients (33%) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11%). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4% had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4%) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1%), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10%. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies.

Original languageEnglish (US)
Article numberofx050
JournalOpen Forum Infectious Diseases
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2017

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Cell Transplantation
Cohort Studies
Prospective Studies
Transplants
Infection
Mortality
Bacteremia
Cytomegalovirus
Nocardia Infections
Morbidity
Clostridium Infections
Transplant Recipients
Pneumocystis carinii
Pneumocystis Pneumonia
Clostridium difficile
Chickenpox
Mycoses
Toxoplasmosis
Cytomegalovirus Infections
Herpes Zoster

Keywords

  • Infections
  • Prospective
  • Stem cell
  • Transplant

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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Infections in hematopoietic cell transplant recipients : Results from the organ transplant infection project, a multicenter, prospective, cohort study. / Schuster, Mindy G.; Cleveland, Angela A.; Dubberke, Erik R.; Kauffman, Carol A.; Avery, Robin; Husain, Shahid; Paterson, David L.; Silveira, Fernanda P.; Chiller, Tom M.; Benedict, Kaitlin; Murphy, Kathleen; Pappas, Peter G.

In: Open Forum Infectious Diseases, Vol. 4, No. 2, ofx050, 01.03.2017.

Research output: Contribution to journalArticle

Schuster, MG, Cleveland, AA, Dubberke, ER, Kauffman, CA, Avery, R, Husain, S, Paterson, DL, Silveira, FP, Chiller, TM, Benedict, K, Murphy, K & Pappas, PG 2017, 'Infections in hematopoietic cell transplant recipients: Results from the organ transplant infection project, a multicenter, prospective, cohort study', Open Forum Infectious Diseases, vol. 4, no. 2, ofx050. https://doi.org/10.1093/ofid/ofx050
Schuster, Mindy G. ; Cleveland, Angela A. ; Dubberke, Erik R. ; Kauffman, Carol A. ; Avery, Robin ; Husain, Shahid ; Paterson, David L. ; Silveira, Fernanda P. ; Chiller, Tom M. ; Benedict, Kaitlin ; Murphy, Kathleen ; Pappas, Peter G. / Infections in hematopoietic cell transplant recipients : Results from the organ transplant infection project, a multicenter, prospective, cohort study. In: Open Forum Infectious Diseases. 2017 ; Vol. 4, No. 2.
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abstract = "Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87{\%}). The overall crude mortality was 52{\%}. Death was due to underlying disease in 44{\%} cases and infection in 21{\%}. Bacteremia occurred in 231 (52{\%}) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45{\%} vs 13{\%}, P = .02). Clostridium difficile infection developed in 148 patients (33{\%}) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11{\%}). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4{\%} had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4{\%}) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1{\%}), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10{\%}. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies.",
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AU - Cleveland, Angela A.

AU - Dubberke, Erik R.

AU - Kauffman, Carol A.

AU - Avery, Robin

AU - Husain, Shahid

AU - Paterson, David L.

AU - Silveira, Fernanda P.

AU - Chiller, Tom M.

AU - Benedict, Kaitlin

AU - Murphy, Kathleen

AU - Pappas, Peter G.

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N2 - Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87%). The overall crude mortality was 52%. Death was due to underlying disease in 44% cases and infection in 21%. Bacteremia occurred in 231 (52%) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45% vs 13%, P = .02). Clostridium difficile infection developed in 148 patients (33%) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11%). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4% had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4%) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1%), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10%. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies.

AB - Background. Infection is a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Our object was to better define the epidemiology and outcomes of infections after HCT. Methods. This was a prospective, multicenter cohort study of HCT recipients and conducted from 2006 to 2011. The study included 4 US transplant centers and 444 HCT recipients. Data were prospectively collected for up to 30 months after HCT using a standardized data collection tool. Results. The median age was 53 years, and median follow up was 413 (range, 5-980) days. The most common reason for HCT was hematologic malignancy (87%). The overall crude mortality was 52%. Death was due to underlying disease in 44% cases and infection in 21%. Bacteremia occurred in 231 (52%) cases and occurred early posttransplant (median day 48). Gram-negative bloodstream infections were less frequent than Gram-positive, but it was associated with higher mortality (45% vs 13%, P = .02). Clostridium difficile infection developed in 148 patients (33%) at a median of 27 days post-HCT. There were 53 invasive fungal infections (IFIs) among 48 patients (11%). The median time to IFI was 142 days. Of 155 patients with cytomegalovirus (CMV) infection, 4% had CMV organ involvement. Varicella zoster infection (VZV) occurred in 13 (4%) cases and was disseminated in 2. Infection with respiratory viruses was seen in 49 patients. Pneumocystis jirovecii pneumonia was rare (1%), and there were no documented cases of nocardiosis, toxoplasmosis, endemic mycoses, or mycobacterial infection. This study lacked standardized antifungal and antiviral prophylactic strategies. Conclusions. Infection remains a significant cause of morbidity and mortality after HCT. Bacteremias and C difficile infection are frequent, particularly in the early posttransplant period. The rate of IFI is approximately 10%. Organ involvement with CMV is infrequent, as are serious infections with VZV and herpes simplex virus, likely reflecting improved prevention strategies.

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KW - Prospective

KW - Stem cell

KW - Transplant

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