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Community‐acquired respiratory virus lower respiratory tract disease in allogeneic stem cell transplantation recipient: Risk factors and mortality from pulmonary virus‐bacterial mixed infections
Author(s) -
Piñana José Luis,
Gómez María Dolores,
Pérez Ariadna,
Madrid Silvia,
BalaguerRoselló Aitana,
Giménez Estela,
Montoro Juan,
González Eva María,
Vinuesa Víctor,
Moles Paula,
HernándezBoluda Juan Carlos,
Salavert Miguel,
Calabuig Marisa,
Sanz Guillermo,
Solano Carlos,
Sanz Jaime,
Navarro David
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12926
Subject(s) - medicine , bronchoalveolar lavage , hematopoietic stem cell transplantation , hazard ratio , pneumonia , transplantation , gastroenterology , respiratory tract infections , respiratory system , immunology , lung , confidence interval
Risk factors ( RF s) and mortality data of community‐acquired respiratory virus ( CARV s) lower respiratory tract disease ( LRTD ) with concurrent pulmonary co‐infections in the setting of allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ) is scarce. From January 2011 to December 2017, we retrospectively compared the outcome of allo‐ HSCT recipients diagnosed of CARV s LRTD mono‐infection (n = 52, group 1), to those with viral, bacterial, or fungal pulmonary CARV s LRTD co‐infections (n = 15, group 2; n = 20, group 3, and n = 11, group 4, respectively), and with those having bacterial pneumonia mono‐infection (n = 19, group 5). Overall survival ( OS ) at day 60 after bronchoalveolar lavage ( BAL ) was significantly higher in group 1, 2, and 4 compared to group 3 (77%, 67%, and 73% vs 35%, respectively, P = .012). Recipients of group 5 showed a trend to better OS compared to those of group 3 (62% vs 35%, P = .1). Multivariate analyses showed bacterial co‐infection as a RF for mortality (hazard ratio[ HR ] 2.65, 95% C.I. 1.2‐6.9, P = .017). We identified other 3 RF s for mortality: lymphocyte count <0.5 × 10 9 /L ( HR 2.6, 95% 1.1‐6.2, P = .026), the occurrence of and CMV DNA emia requiring antiviral therapy ( CMV ‐ DNA emia‐ RAT ) at the time of BAL ( HR 2.32, 95% C.I. 1.1‐4.9, P = .03), and the need of oxygen support ( HR 8.3, 95% C.I. 2.9‐35.3, P = .004). CARV LRTD co‐infections are frequent and may have a negative effect in the outcome, in particular in the context of bacterial co‐infections.