Gastrointestinal graft-versus-host disease increases the risk of post-engraftment bloodstream infections

Yasuo Mori from Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan, and colleagues conducted a retrospective study to evaluate the etiology, morbidity, outcomes, and risk factors of bloodstream infection (BSI) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). The study was published ahead of print in Biology of Bone and Marrow Transplantation.

Patients and methods:

• N = 346 patients
• Median age = 49 years (16–72)
• Allo-HSCT: between July 2009 and December 2016

Key findings:

• Post-engraftment period BSI (PE-BSI): 43/316 (13.6%)
  • 30 patients had one PE-BSI episode
  • 12 patients had two episodes
  • One patient had three episodes
• The median onset of first PE-BSI: 65 days (18–154) after transplant
• 62 pathogens were identified: gram-positive bacteria, gram-negative bacteria, and fungi: 54.8% vs5% vs 9.7%
• Incidence of acute GvHD (grade II to IV) in patients with and without PE-BSI: 36/43 (83.7%) vs 112/273 (41.0%), P < 0.0001
• Risk factors for PE-BSI:
  • Acute gastrointestinal (GI) GvHD: odds ratio (OR) = 8.82 (95% CI, 3.99–5), P < 0.0001
  • Methylprednisolone usage as GvHD prophylaxis: OR = 6.49 (95% CI, 1.49–2), P = 0.013
• 3-year overall survival in patients with PE-BSI compared with those without PE-BSI: 47.0% vs6%, P < 0.001

Taken together, this study indicates that GI-GvHD increases the risk of post-engraftment blood stream infections. The authors suggested that “microbiological monitoring for BSIs and minimizing intestinal dysbiosis may be crucial to break the vicious cycle between GI-GvHD and bacteremia, consequently improve transplant outcomes especially in patients who require additional immunosuppressants.” Providing therapy with novel agents and supportive care for subsequent PE-BSI may improve outcomes and reduce therapy-related mortality.