PMID- 23380342
OWN - NLM
STAT- MEDLINE
DCOM- 20140314
LR  - 20130416
IS  - 1523-6536 (Electronic)
IS  - 1083-8791 (Linking)
VI  - 19
IP  - 5
DP  - 2013 May
TI  - Defining incidence, risk factors, and impact on survival of central 
      line-associated blood stream infections following hematopoietic cell 
      transplantation in acute myeloid leukemia and myelodysplastic syndrome.
PG  - 720-4
LID - S1083-8791(13)00058-X [pii]
LID - 10.1016/j.bbmt.2013.01.022 [doi]
AB  - Central line-associated blood stream infections (CLABSI) commonly complicate the 
      care of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome 
      (MDS) after allogeneic stem cell transplantation (HCT). We developed a modified 
      CLABSI (MCLABSI) definition that attempts to exclude pathogens usually acquired 
      because of disruption of mucosal barriers during the vulnerable neutropenic 
      period following HCT that are generally included under the original definition 
      (OCLABSI). We conducted a retrospective study of all AML and MDS patients 
      undergoing HCT between August 2009 and December 2011 at the Cleveland Clinic 
      (N = 73), identifying both OCLABSI and MCLABSI incidence. The median age at 
      transplantation was 52 years (range, 16 to 70); 34 had a high (>/=3) HCT 
      comorbidity index (HCT-CI); 34 received bone marrow (BM), 24 received peripheral 
      stem cells (PSC), and 15 received umbilical cord blood cells (UCB). Among these 
      73 patients, 23 (31.5%) developed OCLABSI, of whom 16 (69.6%) died, and 8 (11%) 
      developed MCLABSI, of whom 7 (87.5%) died. OCLABSI was diagnosed a median of 9 
      days from HCT: 5 days (range, 2 to 12) for UCB and 78 days (range, 7 to 211) for 
      BM/PSC (P < .001). MCLABSI occurred a median of 12 days from HCT, with similar 
      earlier UCB and later BM/PSC diagnosis (P = .030). Risk factors for OCLABSI in 
      univariate analysis included CBC (P < .001), human leukocyte antigen 
      (HLA)-mismatch (P = .005), low CD34(+) count (P = .007), low total nucleated cell 
      dose (P = .016), and non-Caucasian race (P = .017). Risk factors for OCLABSI in 
      multivariable analysis were UCB (P < .001) and high HCT-CI (P = .002). There was 
      a significant increase in mortality for both OCLABSI (hazard ratio, 7.14; CI, 
      3.31 to 15.37; P < .001) and MCLABSI (hazard ratio, 6.44; CI, 2.28 to 18.18; 
      P < .001). CLABSI is common and associated with high mortality in AML and MDS 
      patients undergoing HCT, especially in UCB recipients and those with high HCT-CI. 
      We propose the MCLABSI definition to replace the OCLABSI definition, given its 
      greater precision for identifying preventable infection in HCT patients.
CI  - Copyright (c) 2013 American Society for Blood and Marrow Transplantation. Published 
      by Elsevier Inc. All rights reserved.
FAU - Lukenbill, Joshua
AU  - Lukenbill J
AD  - Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, 
      Cleveland, OH, USA. lukenbj@ccf.org
FAU - Rybicki, Lisa
AU  - Rybicki L
FAU - Sekeres, Mikkael A
AU  - Sekeres MA
FAU - Zaman, Muhammad Omer
AU  - Zaman MO
FAU - Copelan, Alexander
AU  - Copelan A
FAU - Haddad, Housam
AU  - Haddad H
FAU - Fraser, Thomas
AU  - Fraser T
FAU - DiGiorgio, Megan J
AU  - DiGiorgio MJ
FAU - Hanna, Rabi
AU  - Hanna R
FAU - Duong, Hien
AU  - Duong H
FAU - Hill, Brian
AU  - Hill B
FAU - Kalaycio, Matt
AU  - Kalaycio M
FAU - Sobecks, Ronald
AU  - Sobecks R
FAU - Bolwell, Brian
AU  - Bolwell B
FAU - Copelan, Edward
AU  - Copelan E
LA  - eng
PT  - Journal Article
DEP - 20130201
PL  - United States
TA  - Biol Blood Marrow Transplant
JT  - Biology of blood and marrow transplantation : journal of the American Society for 
      Blood and Marrow Transplantation
JID - 9600628
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Catheter-Related Infections/blood/*etiology/prevention & control
MH  - Catheterization, Central Venous/*adverse effects
MH  - Female
MH  - Hematopoietic Stem Cell Transplantation/*methods
MH  - Humans
MH  - Incidence
MH  - Leukemia, Myeloid, Acute/blood/microbiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Myelodysplastic Syndromes/blood/microbiology/*surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sepsis/*etiology/prevention & control
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2013/02/06 06:00
MHDA- 2014/03/15 06:00
CRDT- 2013/02/06 06:00
PHST- 2012/12/20 00:00 [received]
PHST- 2013/01/23 00:00 [accepted]
PHST- 2013/02/06 06:00 [entrez]
PHST- 2013/02/06 06:00 [pubmed]
PHST- 2014/03/15 06:00 [medline]
AID - S1083-8791(13)00058-X [pii]
AID - 10.1016/j.bbmt.2013.01.022 [doi]
PST - ppublish
SO  - Biol Blood Marrow Transplant. 2013 May;19(5):720-4. doi: 
      10.1016/j.bbmt.2013.01.022. Epub 2013 Feb 1.