Effectiveness of antibacterial prophylaxis with non-absorbable polymyxin B compared to levofloxacin after allogeneic hematopoietic stem cell transplantation

2015 ◽  
Vol 17 (5) ◽  
pp. 647-654
Author(s):  
S. Koh ◽  
K. Yamada ◽  
M. Nishimoto ◽  
Y. Hayashi ◽  
H. Koh ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Polymyxin B ◽  
Antibacterial Prophylaxis ◽  
Hematopoietic Stem

scholarly journals Epidemiology of bacteremia after autologous hematopoietic stem cell transplantation in the absence of antibiotic prophylaxis

2018 ◽  
Vol 12 (02.1) ◽  
pp. 10S
Author(s):  
Rima Moghnieh ◽  
Anas Mugharbil ◽  
Ali Youssef ◽  
Tamima Jisr ◽  
Hani Tamim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Central Line ◽  
Antibacterial Prophylaxis ◽  
Gram Positive ◽  
Hematopoietic Stem ◽  
Gram Negative

Introduction: Bacterial infections are frequent complications occurring after autologous hematopoietic stem-cell transplantation (AHSCT). Herein, we identified the bacterial ecology and its antibiogram in AHSCT patients. We assessed the incidence, contributing factors and outcome of prolonged neutropenia and bacteremia post-AHSCT in the absence of antibacterial prophylaxis. Methodology: This is a retrospective chart review of 190 adult patients who underwent AHSCT for lymphoma and multiple myeloma, between 2005 and 2015 at a Lebanese hospital. Results: Most of the isolated bacteria originated from urine (49%) followed by blood (30%) and were mainly Gram-negative (70%). Fluoroquinolone susceptibility was 57% among Gram-negative and Gram-positive isolates. Bacteremia was documented in 12.6% of the patients, with a predominant gram-negative etiology having 95% susceptibility to fluoroquinolones. The duration of neutropenia, < or > 7 days, did not affect the incidence of bacteremia (11% vs. 14% respectively, p = 0.17). Patients with lymphoma were more likely to have prolonged neutropenia compared to those with myeloma (p < 0.0001). The use of a central line and the development of central-line infections were significantly higher in Gram-positive bacteremia (p = 0.03, p = 0.008 respectively). Mucositis occurred more in Gram-negative bacteremia (p = 0.02). Total mortality rate was 3.7% in the whole population and that attributed to bacteremia was 12.5% in the bacteremia subgroup. Bacteremia was a predictor for mechanical ventilation (p = 0.003), septic shock and mortality (p = 0.025). Conclusion: Since organisms causing bacteremia were still highly susceptible to fluoroquinolones and that the duration of neutropenia post-AHSCT didn't affect bacteremia, we concluded that fluoroquinolone prophylaxis is still valid yet, with close monitoring of resistance.

scholarly journals Combination of Four Drugs for Bloodstream Infection Caused By Carbapenem-Resistant Enterobacteriaceae in Severe Agranulocytosis Patients after Hematopoietic Stem Cell Transplantation

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5664-5664
Author(s):  
Yaqun Hong ◽  
Xiaofan Li ◽  
Xianling Chen ◽  
Ping Chen ◽  
Meiling Chen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Combination Therapy ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Polymyxin B ◽  
Resistant Bacteria ◽  
Hematopoietic Stem ◽  
First Time

Bloodstream infection (BSI) caused by multidrug‐resistant bacteria (MDRB) or extensively drug-resistant bacteria (XDRB) in immunocompromised and neutropenic patients after hematopoietic stem cell transplantation (HSCT) is a global threaten. However, effective treatment regimen is still controversial and inadequate due to the rapid deterioration, the horrific evolution of bacteria and high mortality that the mortality related to BSI caused by carbapenem-resistant Enterobacteriaceae (CRE) is 51% in adult neutropenic patients[1]. Here, we presented four cases that CRE was detected in blood of severe agranulocytosis patients undergoing HSCT. All patients ranged from 2 to 50 years old were diagnosed as hematologic disease. CREs were detected within 1 month from the date of engraftment. In case 1, a 6-year-old boy with high-risk B-cell acute lymphocyte leukaemia received halpo-HSCT after chimeric antigen receptor T-cell therapy and the 20th chemotherapy, ultimately, he died from acute graft versus host disease and BSI that tienam and tigecycline showed little effect though the MIC value of tigecycline was less than 0.5ug/ml. The second patient is a 25-year-old female who was diagnosed as hemophagocytic syndrome with recurrent fever and a salvage haploidentical transplantation combining with a unit of umbilical cord blood stem cells was performed. Finally, she died from BSI caused by CRE although a combination therapy using polymyxin B, tigecycline and doubled-dose Tienam was given, which subsequently was changed to another therapeutic regimen using a higher dose tigecycline and fosfomycin and polymyxin B in light of the resistance of tienam. Patients in case 3 and case 4 received a combination therapy with tigecycline, polymyxin B, fosfomycin, and Tienam intravenously. For the 29-month-old boy diagnosed as acute monocytic leukemia with high expression of WT1 and abnormal karyotype and treated with cord blood stem cell transplantation in case 3, the tigecycline was given with a dose of 2.4mg/kg at the first time, followed by doses of 1.2mg per dose every 12 hours, and a dose of 2.0mg/kg at the first time, followed by doses of 1.25mg/kg per dose every 12 hours of polymyxin B, 0.15g/kg per every 12 hours of fosfomycin, as well as 30mg/kg per dose every 6 hours of imipenem were administrated. For the 50-year-old woman with multiple myeloma receiving an autologous hematopoietic stem cell transplantation (auto-HSCT) in case 4, the dose of tigecycline was 100mg at the first time, followed by doses of 1.2mg per dose every 12 hours. Fosfomycin with the dose of 8.0g was used every 12 hours, and the dose of imipenem was1.0g per dose every 6 hours, also, polymyxin B was administrated with a dose of 2.0mg/kg at the first time, followed by doses of 1.25mg/kg per dose every 12 hours. Consequently, patients in case 3 and case 4 were survival. Therefore, a strong combination therapy, as well as the emergency of new drugs might be considered in immunocompromised and neutropenic ill patients with BSI caused by MDRB or XDRB. Disclosures No relevant conflicts of interest to declare.

scholarly journals 574. De-escalation of Broad Spectrum Antibiotics during Cytokine Release Syndrome with Haploidentical Hematopoietic Stem Cell Transplantation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S352-S352
Author(s):  
Molly Schiffer ◽  
Sarah Perreault ◽  
Dayna McManus ◽  
Francine Foss ◽  
Lohith Gowda ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Broad Spectrum ◽  
Antibacterial Prophylaxis ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Hematopoietic Stem

Abstract Background Fever is a common component of cytokine release syndrome (CRS) occurring in 90% of patients undergoing haploidentical hematopoietic stem cell transplantation (Haplo-HSCT). Fevers typically occur between the stem cell infusion (Day 0) and initiation of post-transplant cyclophosphamide and are often confused with febrile neutropenia (FN). Due to longer time to engraftment in Haplo-HSCT, CRS/FN exposes patients to prolonged courses of empiric broad spectrum antibiotic (BSA) therapy increasing the risk for multi-drug resistant organisms. Recently, at Yale New Haven Health, our practice has changed to now recommend antibiotic de-escalation to prophylaxis after 7 days of BSA if no infection is identified. The objective of this study was to assess the incidence of breakthrough infections with the de-escalation of BSA in CRS/FN. Secondary endpoints include rate of FN, rate of de-escalation, rate of recurrent fevers, duration of BSA, and positive blood culture data. Methods The patient population included those undergoing Haplo-HSCT between July 2016 and February 2020 and who developed CRS/FN between Day 0 and Day +5. Patients were excluded if they had prolonged hospitalization due to non-infectious complications or engraftment failure. Bacteremia was defined using NHSN definitions. Results Of the 53 Haplo-HSCTs assessed, 43 experienced CRS/FN. Thirty-five Haplo-HSCT (81%) with CRS/FN had negative cultures and 23 (66%) of these were de-escalated back to antibacterial prophylaxis. The median duration of BSA in the de-escalated group was 7 days (range 5–13) compared to 16.5 days range (13–21) in the non-de-escalated group (p&lt; 0.001). Among those de-escalated, 7 (30%) had recurrent fever occurring at a median of 4 days (range 2–14) and were placed back on BSA. Two Haplo-HSCT (9%) that had fever after de-escalation developed a breakthrough bacteremia. No Haplo-HSCT after de-escalation had fever or re-admission for bacteremia 30 days after engraftment. Four Haplo-HSCT (9%) with CRS/FN had positive blood cultures; however, three (7%) were still able to be de-escalated from BSA to narrower agents based on susceptibilities. Conclusion De-escalation of BSA in FN/CRS in Haplo-HSCT patients reduced unnecessary, prolonged antibiotic exposure with a low incidence of breakthrough infections. Disclosures All Authors: No reported disclosures

Caregiver perspectives on psychosocial care in pediatric hematopoietic stem cell transplantation (HCT).

2020 ◽  
Vol 8 (1) ◽  
pp. 67-78 ◽  
Author(s):  
Anne E. Kazak ◽  
Avi Madan Swain ◽  
Ahna L. H. Pai ◽  
Kimberly Canter ◽  
Olivia Carlson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Psychosocial Care ◽  
Hematopoietic Stem
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