70 (33.5%) patients had 92 pre-engraftment BSI/ 33 (15.8%) patients had 44 post-engraftment BSI

The median onset of the first pre-engraftment BSI was 9 days after transplantation (range, day -12 to day 27)

In the pre-engraft- ment phase, 8 patients developed BSI twice, 2 patients developed BSI 3 times, and 1 patient developed BSI 4 times.

CoNS were the most commonly isolated GPB, while Stenotrophomonas maltophilia and Pseudomonas aeruginosa were the most commonly isolated GNB.

The distribution of GPB/GNB ratio over the years was 1.5 (3/2) in 2007, 3.8 (19/5) in 2008, 3 (24/8) in 2009, 6.5 (13/2) in 2010, 3 (6/2) in 2011, 2.8 (14/5) in 2012, and 2.8 (17/6) in 2013,

With regard to the effect of mucositis, most patients in this cohort developed mucositis of Bearman’s grade II–IV, and therefore, we could not analyze the effect of mucositis on the GPB/GNB ratio.

Among 70 pre-engraftment BSI, death was attribut- able to BSI in 6 (8.6%) (2 with P. aeruginosa, and 1 each with Klebsiella pneumoniae, S. maltophilia, Pseudomo- nas picketti, and Trichosporon asahii).

We retrospectively evaluated the incidence, characteristics of, and risk factors for BSI at both pre- and post-engraftment in 209 adult HSCT patients at our institute between June 2006 and December 2013.

Overall survival at day 180 was 78.5% (95% CI: 72.3– 83.5%). Overall survival did not differ significantly between patients with and without BSI (73.4% vs. 82.6%, P = 0.08) (Fig. 2A). However, pre-engraftment BSI was associated with an increased risk of death (70.0% vs. 82.7%, P = 0.02) (Fig. 2B). Survival was similar for patients with or without post-engraftment BSI (79.4% vs. 84.5%, P = 0.44) (Fig. 2C).

time >261 days from diagnosis to HSCT, high-risk disease status at HSCT, myeloablative conditioning, type of transplant, and engraftment failure

A multi- variate analysis by backward stepwise Fine and Gray proportional-hazard modeling showed that >261 days from diagnosis to HSCT (hazard ratio [HR]: 2.17, 95% CI: 1.33–3.53, P = 0.001), engraftment failure (HR: 2.00, 95% CI: 1.25–3.21, P = 0.003), and high-risk disease status at HSCT (HR: 1.94, 95% CI: 1.23–3.08, P = 0.004) were associated with a significantly higher incidence of pre-engraftment BSI

7-year retrospective study of patients undergoing HSCT at the transplant unit of Department of Hematology at Rui Jin Hospital between January 1, 2008 and December 30, 2014. The aims of this study were: to describe epidemiology and outcome of BSI in neutropenic patients underwent HSCT; to understand the risk factors of BSI associated mortality. All patients undergoing HSCT with neutropenic (neutrophil count < 0.5 109/L) fever with docu- mented BSI were included for analyzed

348 episodes of neutropenic fever in 273 patients were documented.

only 89 (22.5%) episodes in 85 patients were found to have documented BSI (85 primary BSI and 4 second- ary BSI).

A total of 83 patients had documented BSI at median of 5 days (3 – 9) after transplantatio

gram-positive and gram-negative BSI were 22 (25.9%) and 50 (58.8%)

In the GNB, E coli was the most common bloodstream isolates (n 1⁄4 36, 47.4%) followed by K pneumoniae (n 1⁄4 24, 31.6%) and then S maltophilia (n 1⁄4 3, 3.5%) and P aeruginosa (n 1⁄4 3, 3.5%),

For GPB, coagulase- negative Staphylococcus spp. (n 1⁄4 20, 68.9%) were most com- monly documented followed by Enterococcus (n 1⁄4 3, 10.3%) and S aureus (n 1⁄4 2, 6.9%)

More importantly, besides S maltophilia isolates, a total of 9 isolated were resistant to carbapenem with an incidence of carbapenem-resistant enterobacteriaceae (CRE) as high as 12.3% (9/73) mostly documented in K pneumoniae (4/24, 16.7%) and other Enterobacteriaceae

patients with high-risk disease (P1⁄40.014), undergoing allo- geneic HSCT (P 1⁄4 0.04), BSI with carbapenem-resistant GNB(P < 0.001), and prolonged neutropenia ( 15 days, P < 0.001) were associated with BSI-related mortality in univariate analysis

high-risk disease (P 1⁄4 0.031, RR 4.4), BSI with carbapenem-resistant GNB (P1⁄40.04, RR 4.4) and prolonged neutropenia ( 15 days, P 1⁄4 0.007, RR 16.7) remained signifi- cant with multivariate analysis

When combined these 3 risk factors, it was possible to divide patients into 3 different risk groups for BSI-related mortality: low-risk with 0 to 1 risk factor, intermediate-risk with 2 risk factors, and high-risk with 3 risk factors. Patients in the low-risk group had a BSI-related mortality at 4.5 1.5%, while intermediate- and high-risk patients had significantly increased BSI-related mortality to 41.7 14.2% and 83.3 15.2%, respectively,

This retrospective study included 514 consecutive patients undergoing 543 allogeneic HSCTs between 2001 and 2008. The inclusion criterion was an absolute neutrophil count <0.5 9 109/L at least once after conditioning and was met in 521 transplantations performed in 493 patients

In 109 transplantations, 120 episodes of BSI occurred, giving an incidence of at least 1 episode of BSI of 21% (109/521), and an incidence of 2 BSIs of 2% (11/521).

The median time to onset of BSI was 8 days (range 0–28) after HSCT. BSI with viridans streptococci and Escherichia coli occurred significantly earlier after HSCT than BSI with Enterococcus species (median time 4, 8, and 11 days, respectively

For patients with BSI, the crude mortality rates 30 days after transplantation and 30 days after the last episode of BSI were 5.5% (6/109 patients) and 8.2% (9/109 patients),

The crude mortality at day 30 for patients with no BSI was 1.1% (4 deaths in 412 transplantations), which was significantly lower than that for patients with BSI (P = 0.01 compared with mortality 30 days after transplantation,

The attributable mortality in patients with isolates of CoNS of unclear significance and no other BSI was 0% (0/22). Crude mortality 30 days after transplantation was 0% (0/22), and crude mortality 30 days after positive blood culture was 4.5% (1/22).

During the period 1975–1986, 6 episodes of gram- negative BSI occurred in 154 patients (3.9%) who were transplanted without systemic antibacterial prophy- laxis. Ciprofloxacin was then introduced as gram- negative prophylaxis during neutropenia, and is still used. Between 1986 and 1996, 1 episode of gram- negative BSI occurred in 346 patients (0.3%). Between 2001 and 2004, 6 gram-negative BSIs occurred in 247 transplantations (2.4%), and between 2005 and 2008 11 gram-negative BSIs occurred in 274 transplantations (4.0%). The rates of gram-negative BSI in 2001–2004 and in 2005–2008 were significantly higher than the rate in 1986–1996 (P = 0.02 for 2001–2004, P < 0.001 for 2005–2008).

the crude mortality at day 120 after transplantation was as high as 21% in patients with BSI compared to 10% in patients with no BSI.