Dataset Information

Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index.

ABSTRACT: Hematopoietic cell transplant (HCT) recipients have lower immune response to influenza vaccination and are susceptible to lower respiratory tract infection (LRI) and death. We determined clinical characteristics and outcomes of laboratory-confirmed influenza, including 2014/H3N2 infection, in 146 HCT recipients. An immunodeficiency scoring index (ISI) was applied to identify patients at high risk for LRI and death. Thirty-three patients (23%) developed LRI and 7 (5%) died within 30 days of diagnosis. Most patients received antiviral therapy (83%); however, only 18% received it within 48 hours of symptom onset. The incidence of LRI was significantly higher in the ISI high-risk group than it was in the low-risk group (P < .001). Receiving early antiviral therapy was associated with a substantial reduction in LRI for all ISI risk groups with the greatest risk reduction observed in the high-risk group. When compared with previous seasons, no significant differences in patient outcomes were observed during the 2014/H3N2 season; however, antiviral therapy was more promptly initiated in the latter season. The ISI that was originally developed for respiratory syncytial virus may help identify HCT recipients at risk for progression to LRI and mortality after influenza infection. These patients should be monitored more closely. Early initiation of antiviral therapy for influenza in HCT recipients, regardless of the ISI risk group, may improve morbidity as well as mortality.

SUBMITTER: Kmeid J

PROVIDER: S-EPMC4753109 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index.

Kmeid Joumana J Vanichanan Jakapat J Shah Dimpy P DP El Chaer Firas F Azzi Jacques J Ariza-Heredia Ella J EJ Hosing Chitra C Mulanovich Victor V Chemaly Roy F RF

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 20151127 3

Hematopoietic cell transplant (HCT) recipients have lower immune response to influenza vaccination and are susceptible to lower respiratory tract infection (LRI) and death. We determined clinical characteristics and outcomes of laboratory-confirmed influenza, including 2014/H3N2 infection, in 146 HCT recipients. An immunodeficiency scoring index (ISI) was applied to identify patients at high risk for LRI and death. Thirty-three patients (23%) developed LRI and 7 (5%) died within 30 days of diagn ...[more]

PMID: 26638804

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Project description:BackgroundBloodstream infections (BSIs) are common after hematopoietic stem cell transplantation (HSCT) and are associated with increased long-term morbidity and mortality. However, short-term outcomes related to BSI in this population remain unknown. More specifically, it is unclear whether choices related to empiric antimicrobials for potentially infected patients are associated with patient outcomes.Research questionAre potential delays in appropriate antibiotics associated with hospital outcomes among HSCT recipients with BSI?Study design and methodsWe conducted a retrospective cohort study at a large comprehensive inpatient academic cancer center between January 2014 and June 2017. We identified all admissions for HSCT and prior recipients of HSCT. We defined potential delay in appropriate antibiotics as > 24 h between positive blood culture results and the initial dose of an antimicrobial with activity against the pathogen.ResultsWe evaluated 2,751 hospital admissions from 1,086 patients. Of these admissions, 395 (14.4%) involved one or more BSIs. Of these 395 hospitalizations, 44 (11.1%) involved potential delays in appropriate antibiotics. The incidence of mortality was higher in BSI hospitalizations than in those without BSI (23% vs 4.5%; P < .001). In multivariable analysis, BSI was an independent predictor of mortality (OR, 8.14; 95% CI, 5.06-13.1; P < .001). Mortality was higher for admissions with potentially delayed appropriate antibiotics than for those with appropriate antibiotics (48% vs 20%; P < .001). Potential delay in antibiotics was also an independent predictor of mortality in multivariable analysis (OR, 13.8; 95% CI, 5.27-35.9; P < .001).InterpretationBSIs were common and independently associated with increased morbidity and mortality. Delays in administration of appropriate antimicrobials were identified as an important factor in hospital morbidity and mortality. These findings may have important implications for our current practice of empiric antibiotic treatment in HSCT patients.

Project description:Influenza is a common respiratory tract infection in solid organ transplant (SOT) recipients. We aimed to investigate the incidence, risk factors, and complications of influenza in a large cohort of kidney and liver transplant recipients over 10 consecutive seasons. We conducted a retrospective study, including 378 liver and 683 kidney transplant recipients who were transplanted from January 1, 2010, to October 1, 2019. The data on influenza were retrieved from MiBa, which is a nationwide database that contains all of the microbiology results in Denmark. Clinical data were retrieved from patient records. Incidence rates and cumulative incidences were calculated, and risk factors were investigated using time-updated Cox proportional hazards models. The cumulative incidence of influenza in the first 5 years posttransplantation was 6.3% (95% CI: 4.7 to 7.9%). Of the 84 influenza positive recipients, 63.1% had influenza A, 65.5% were treated with oseltamivir, 65.5% were hospitalized, and 16.7% developed pneumonia. There were no significant differences in outcomes when comparing patients with influenza A and B. We found no significant effect of same-season influenza vaccination, sex, age, or comorbidities on the risk of acquiring influenza. The incidence of influenza in kidney and liver recipients is high, and 65.5% of infected transplant recipients required hospitalization. We were not able to confirm a reduction in influenza incidence or in the risk of complications associated with vaccination. IMPORTANCE Influenza is a common respiratory virus in solid organ transplant recipients that may have severe complications, including pneumonia and hospitalization. This study investigates the incidence, risk factors, and complications of influenza in a Danish cohort of kidney and liver transplant recipients over 10 consecutive influenza seasons. The study shows a high incidence of influenza and a high frequency of both pneumonia and hospitalization. This emphasizes the importance of continuous focus on influenza in this vulnerable group. During the COVID-19 pandemic, the incidence of influenza has been low due to COVID-related restrictions, and immunity may have waned. However, as most countries have now opened up, the incidence of influenza is expected to be high this season.

Dataset Information

Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index.

Publications

Outcomes of Influenza Infections in Hematopoietic Cell Transplant Recipients: Application of an Immunodeficiency Scoring Index.

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