Table 5.
Details on the length of hospital stay, the rate of hospital readmission within 100 days after transplant, antibiotic treatment’s characteristics of the first episode of FN, and the frequency of subsequent bloodstream infection in allo-HSCT cohort
| LEVO-group | NO-LEVO-group | P value | |
|---|---|---|---|
| Duration of hospitalization (d) | 41 (31-55) | 37 (29-46) | .130 |
| Health care use (rehospitalization within 100 d from transplant) | 11 (25%)∗ | 21 (18.6%)† | .384 |
| Broad-spectrum antibiotics at the onset of the first FN episode | .002 | ||
| Ceftazidime | 9 (13.0%) | 2 (1.3%) | |
| Meropenem | 10 (14.5%) | 16 (10.6%) | |
| Piperacillin/tazobactam | 48 (69.6%) | 129 (85.4%) | |
| Others | 2 (2.9%) | 4 (2.7%) | |
| Escalation approach, yes | 44 (64%) | 74 (49%) | .058 |
| Days to antibiotic escalation since the onset of the first FN episode | 3 (2.5-5.5) | 2.5 (2-4) | .003 |
| Type of antibiotic escalation‡ | .646 | ||
| Vancomycin or daptomycin addition | 21 (47.7%) | 42 (56.8%) | |
| Amikacin or gentamycin addition | 5 (11.4%) | 12 (16.2%) | |
| Escalation to carbapenem | 31 (70.5%) | 48 (64.9%) | |
| Duration of antibiotic therapy to treat the first FN episode (d) | 17 (12-23) | 14 (10-20) | .002 |
| Reason of antibiotic therapy stop | .066 | ||
| Discontinuation (still in aplasia or after engraftment) | 47 (72.3%) | 86 (58.9%) | |
| Escalation for a second FN episode | 18 (27.7%) | 60 (41.1%) | |
| C difficile infection within 100 d | 11 (15.5%) | 18 (11.8%) | .522 |
| ESBL-producing bacteria BSI within 100 d since transplant§ | 1 (1.5%)‖ | 5 (3.5%)¶ | .667 |
| CR-GNB BSI within 100 d since transplant§ | 1 (1.5%)# | 1 (0.7%)∗∗ | .535 |
Results reported as median (IQR) or frequency (%); comparisons by Wilcoxon rank-sum test or χ2/Fisher exact test.
Reasons for rehospitalization: immune-mediated encephalopathy 1, possible hepatic-splenic candidiasis 1, clinically-relevant Cytomegalovirus infection 2, fever without microbiologically nor clinically documented infections 2, urinary tract infection 1, cutaneous lesions 1, pan-colitis 1, acute respiratory failure after central venous line removal 1, para-thyroidectomy intervention 1.
Reasons for rehospitalization: acute GVHD 3, viral infections 10 (2 COVID-19, 1 syncytial respiratory virus bronco-pneumonitis, 1 parainfluenza virus bronco-pneumonitis, 3 possible gastrointestinal HHV6 diseases, 1 HHV6 reactivation, 2 BK hemorrhagic cystitis, 1 adenovirus reactivation associated to urinary sepsis), bacterial infections 5 (1 ESBL-E coli BSI, 1 S. epidermidis BSI, 3 pneumonia), probable pulmonary aspergillosis 1, diarrhea 1, myocarditis 1.
Description of antibiotic escalation in supplemental Table 2.
Patients’ distribution according to ESBL BSI or CR BSI or acute GVHD occurrence within 100 days since HSCT and corresponding details in supplemental Table 3; denominators of these proportions did not include patients who died without achieving neutrophils engraftment.
One ESBL-E coli.
One ESBL-E coli, 4 ESBL-K pneumoniae.
One CR-Citrobacter freundii.
One CR-P aeruginosa.