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Infection prevention practices among EBMT hematopoietic cell transplant centers: the EBMT Infectious Disease Working Party survey

Bone Marrow Transplantation volume 58, pages 414–423 (2023)Cite this article

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Abstract

We aimed to describe the current status of infection prevention practices among EBMT centers. Questionnaires were distributed to all 553 EBMT transplant centers to capture clinical practices regarding antimicrobial prophylaxis, protective measures, isolation procedures and growth-factor support of patients undergoing hematopoietic cell transplantation. Responses from 127 centers in 32 countries were obtained. Most centers housed patients in single rooms (autologous-82%; allogeneic-98%), with high-efficiency particulate air (HEPA)-filters (autologous-73%; allogeneic-100%) and positive pressure (autologous-61%; allogeneic-88%). Pre-engraftment G-CSF was utilized by 77 and 31% of centers after autologous and allogeneic transplantation, respectively (P < 0.00001). Antibacterial prophylaxis was provided by 57 and 69% (P = 0.086) of centers and antifungal prophylaxis by 65 and 84% (P = 0.0008) of centers, to patients undergoing autologous and allogeneic transplantation, respectively. Yet, 16 and 3% of centers provided neither antibacterial nor antifungal prophylaxis to patients undergoing autologous and allogeneic transplantation, respectively. Considerable variation existed between centers and across countries in antimicrobial prophylaxis practices, medications employed and duration of preventive therapy. There were considerable discordances between guidelines and daily practices. JACIE accredited and non-accredited centers did not differ significantly in their antimicrobial prophylaxis practices. Whether these differences between transplant centers translated into differences in infectious morbidity, mortality and financial costs, warrants further research.

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Fig. 1: EBMT-IDWP Registry data: autologous HCT (n = 116).
Fig. 2: EBMT-IDWP Registry data: allogeneic HCT (n = 108).

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Bow E, Wingard JR. Overview of neutropenic fever syndromes. https://www.uptodate.com/contents/overview-of-neutropenic-fever-syndromes.

  2. Sahin U, Toprak SK, Atilla PA, Atilla E, Demirer T. An overview of infectious complications after allogeneic hematopoietic stem cell transplantation. J Infect Chemother. 2016;22:505–14.

    Article  PubMed  Google Scholar 

  3. Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Hematol Oncol Clin North Am. 2011;25:101–16.

    Article  PubMed  Google Scholar 

  4. Collin BA, Leather HL, Wingard JR, Ramphal R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis. 2001;33:947–53.

    Article  CAS  PubMed  Google Scholar 

  5. Kontoyiannis DP, Marr KA, Park BJ, Barbara DA, Elias JA, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) database. Clin Infect Dis. 2010;50:1091–100.

    Article  PubMed  Google Scholar 

  6. Srinivasan A, Wang C, Srivastava DK, Burnette K, Shenep JL, Leung W, et al. Timeline, epidemiology, and risk factors for bacterial, fungal, and viral infections in children and adolescents after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transpl. 2013;19:94–101.

    Article  Google Scholar 

  7. Auletta JJ, Kou J, Chen M, Shaw BE. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR US summary slides, 2021.

  8. Krüger WH, Bohlius J, Cornely OA, Einsele H, Hebart H, Massenkeil G, et al. Antimicrobial prophylaxis in allogeneic bone marrow transplantation. Guidelines of the infectious diseases working party (AGIHO) of the German society of haematology and oncology. Ann Oncol. 2005;16:1381–90.

    Article  PubMed  Google Scholar 

  9. Leibovici L, Paul M, Cullen M, Bucaneve G, Gafter-Gvili A, Fraser A. et al. Antibiotic prophylaxis in neutropenic patients. New evidence, practical decisions. Cancer. 2006;107:1743–51.

    Article  CAS  PubMed  Google Scholar 

  10. Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transpl. 2009;15:1143–238.

    Article  CAS  Google Scholar 

  11. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–e93.

    Article  PubMed  Google Scholar 

  12. National Comprehensive Cancer Network (NCCN). Prevention and Treatment of Cancer-Related Infections. NCCN Guidelines Version 2.2022. Retrieved September 2022 from (http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive).

  13. Mikulska M, Averbuch D, Tissot F, Cordonnier C, Akova M, Calandra T, et al. European Conference on Infections in Leukemia (ECIL). Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. J Infect. 2018;76:20–37.

    Article  PubMed  Google Scholar 

  14. Maertens JA, Girmenia C, Brüggemann RJ, Duarte RF, Kibbler CC, Ljungman P, et al. European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother. 2018;73:3221–30.

    CAS  PubMed  Google Scholar 

  15. Egan G, Robinson PD, Martinez JPD, Alexander S, Ammann RA, Dupuis LL, et al. Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials. Cancer Med. 2019;8:4536–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018;36:3043–54.

    Article  PubMed  Google Scholar 

  17. Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, et al. Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology (AGIHO/DGHO) and the DAG-KBT (German Working Group for Blood and Marrow Transplantation). Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol. 2016;95:1435–55.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ljungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, et al. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19:e260–e272.

    Article  PubMed  Google Scholar 

  19. Christopeit M, Schmidt-Hieber M, Sprute R, Buchheidt D, Hentrich M, Karthaus M, et al. Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2021;100:321–36.

    Article  CAS  PubMed  Google Scholar 

  20. Lehrnbecher T, Fisher BT, Phillips B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for antibacterial prophylaxis administration in pediatric cancer and hematopoietic stem cell transplantation. Clin Infect Dis. 2020;71:226–36.

    Article  CAS  PubMed  Google Scholar 

  21. Krüger WH, Hornung RJ, Hertenstein B, Kern WV, Kröger N, Ljungman P, et al. Practices of infection disease prevention and management during hematopoietic cell transplantation: a survey from the European Group for Blood and Marrow Transplantation. J Hematother Stem Cell Res. 2001;10:895–903.

    Article  PubMed  Google Scholar 

  22. Trifilio S, Verma A, Mehta J. Antibacterial prophylaxis in hematopoietic stem cell transplant recipients: heterogeneity of current clinical practice. Bone Marrow Transpl. 2004;33:735–9.

    Article  CAS  Google Scholar 

  23. Hicheri Y, Einsele H, Martino R, Cesaro S, Ljungman P, Cordonnier C. Environmental prevention of infection in stem cell transplant recipients: a survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Transpl Infect Dis. 2013;15:251–8.

    Article  CAS  PubMed  Google Scholar 

  24. Lee SJ, Astigarraga CC, Eapen M, Artz AS, Davies SM, Champlin R, et al. Variation in supportive care practices in hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2008;14:1231–8.

    Article  Google Scholar 

  25. Rasheed W, Ghavamzadeh A, Hamladji R, Ben Othman T, Alseraihy A, Abdel-Rahman F, et al. Hematopoietic stem cell transplantation practice variation among centers in the Eastern Mediterranean Region (EMRO): Eastern Mediterranean Bone Marrow Transplantation (EMBMT) group survey. Hematol Oncol Stem Cell Ther. 2013;6:14–9.

    Article  PubMed  Google Scholar 

  26. Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol 2016;27:v111–8.

    Article  CAS  PubMed  Google Scholar 

  27. Smith TJ, Bohlke K, Lyman GH, Carson KR, Crawford J, Cross SJ, et al. American Society of Clinical Oncology. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2015;33:3199–212.

    Article  CAS  PubMed  Google Scholar 

  28. Gupta AK, Meena JP, Haldar P, Tanwar P, Seth R. Impact of G-CSF administration post-allogeneic hematopoietic stem-cell transplantation on outcomes: a systematic review and meta-analysis. Am J Blood Res. 2021;11:544–63.

    PubMed  PubMed Central  Google Scholar 

  29. Lehrnbecher T, Averbuch D, Castagnola E, Cesaro S, Ammann RA, Garcia-Vidal C, et al. 8th European Conference on Infections in Leukaemia. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 2021;22:e270–e280.

    Article  PubMed  Google Scholar 

  30. Marty FM, Ljungman P, Chemaly RF, Maertens J, Dadwal SS, Duarte RF, et al. Letermovir Prophylaxis for Cytomegalovirus in hematopoietic-cell transplantation. N. Engl J Med. 2017;377:2433–44.

    Article  CAS  PubMed  Google Scholar 

  31. Sandler RD, Tattersall RS, Schoemans H, Greco R, Badoglio M, Labopin M, et al. Diagnosis and Management of Secondary HLH/MAS Following HSCT and CAR-T Cell Therapy in Adults; A Review of the Literature and a Survey of Practice Within EBMT Centres on Behalf of the Autoimmune Diseases Working Party (ADWP) and Transplant Complications Working Party (TCWP). Front Immunol. 2020;11:524.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Agreiter I, Kozijn AE, Bakunina K, Averbuch D, Stringer J, Hutt D, et al. Nurses Group and Infectious Diseases Working Party of EBMT. Contribution of nurses to protective environment in haematopoietic cell transplant setting: an international survey by the European Society for Blood and Marrow Transplantation. Bone Marrow Transpl. 2021;56:1433–40.

    Article  Google Scholar 

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Acknowledgements

We thank all the participating EBMT centers, physicians, and local data managers for their contribution.

Author information

Authors and Affiliations

  1. Institution of Hematology, Rabin Medical Center, Petach-Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Moshe Yeshurun, Uri Rozovski, Liat Shargian & Oren Pasvolsky

  2. EBMT Leiden Study Unit, Dept. of Medical Statistics & Bioinformatics, Leiden, the Netherlands

    Steffie van der Werf, Gloria Tridello & Nina Knelange

  3. Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Malgorzata Mikulska

  4. Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland

    Jan Styczynski

  5. Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel

    Diana Averbuch

  6. Department of Hematology, Hospital de la Princesa, Madrid, Spain

    Rafael de la Camara

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  1. Moshe Yeshurun
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Contributions

MY designed the study, prepared the survey, reviewed and analysed the data, and wrote the paper. DA, MM, JS, RdlC, LS, and OP prepared the survey, contributed to the study conception and design. UR performed the statistical analyses. SvdW, GT, and NK collected the data. All authors edited and approved the final version of the manuscript.

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Correspondence to Moshe Yeshurun.

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Yeshurun, M., Rozovski, U., Shargian, L. et al. Infection prevention practices among EBMT hematopoietic cell transplant centers: the EBMT Infectious Disease Working Party survey. Bone Marrow Transplant 58, 414–423 (2023). https://doi.org/10.1038/s41409-023-01916-6

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