Bacterial Infections

  • Diana AverbuchEmail author


Bloodstream infections (BSI) are the most frequent bacterial infections in HSCT patients; they occur in 5–10% of auto-HSCT and 20–50% of allo-HSCT patients, with higher rates before engraftment, and are associated with increased morbidity and mortality (Tomblyn et al. 2009; Girmenia et al. 2017; Weisser et al. 2017; Mikulska et al. 2018a). Microbiological documentation of skin and soft tissue infection, pneumonia, and typhlitis is frequently missing.


  1. Averbuch D, Cordonnier C, Livermore DM, et al. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica. 2013a;98:1836–47.CrossRefGoogle Scholar
  2. Averbuch D, Orasch C, Cordonnier C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013b;98:1826–35.CrossRefGoogle Scholar
  3. Averbuch D, Tridello G, Hoek J, et al. Antimicrobial resistance in gram-negative rods causing bacteremia in hematopoietic stem cell transplant recipients: intercontinental prospective study of the infectious diseases working party of the European bone marrow transplantation group. Clin Infect Dis. 2017;65:1819–28.CrossRefGoogle Scholar
  4. Bassetti M, Giacobbe DR, Giamarellou H, et al. Management of KPC-producing Klebsiella pneumoniae infections. Clin Microbiol Infect. 2018;24:133–44.CrossRefGoogle Scholar
  5. Cordonnier C, Ljungman P, Juergens C, et al. Immunogenicity, safety, and tolerability of 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine in recipients of allogeneic hematopoietic stem cell transplant aged ≥2 years: an open-label study. Clin Infect Dis. 2015;61:313–23.CrossRefGoogle Scholar
  6. Debast SB, Bauer MP, Kuijper EJ, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014;20(Suppl 2):1–26.CrossRefGoogle Scholar
  7. ECIL-meeting. Vaccines in stem cell transplant patients. 2017. Retrieved 31 Mar 18, 2018.
  8. Engelhard D, Cordonnier C, Shaw PJ, et al. Early and late invasive pneumococcal infection following stem cell transplantation: a European Bone Marrow Transplantation survey. Br J Haematol. 2002;117:444–50.CrossRefGoogle Scholar
  9. Freifeld AG, Bow EJ, Sepkowitz KA, 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:e56–93.CrossRefGoogle Scholar
  10. Gafter-Gvili A, Fraser A, Paul M, et al. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev. 2012;1:CD004386.PubMedPubMedCentralGoogle Scholar
  11. Girmenia C, Bertaina A, Piciocchi A, et al. Incidence, risk factors and outcome of pre-engraftment gram-negative bacteremia after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey. Clin Infect Dis. 2017;65:1884–96.PubMedGoogle Scholar
  12. Gudiol C, Royo-Cebrecos C, Abdala E, et al. Efficacy of beta-lactam/beta-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum-beta-lactamase-producing Enterobacteriaceae in hematological patients with neutropenia. Antimicrob Agents Chemother. 2017;61:e00164–17.CrossRefGoogle Scholar
  13. Gutierrez-Gutierrez B, Salamanca E, de Cueto M, et al. Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study. Lancet Infect Dis. 2017;17:726–34.CrossRefGoogle Scholar
  14. Mikulska M, Raiola AM, Galaverna F, et al. Pre-engraftment bloodstream infections after allogeneic hematopoietic cell transplantation: impact of T cell-replete transplantation from a haploidentical donor. Biol Blood Marrow Transplant. 2018a;24:109–18.CrossRefGoogle Scholar
  15. Mikulska M, Averbuch D, Tissot F, et al. Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. J Infect. 2018b;76:20–37.CrossRefGoogle Scholar
  16. Mikulska M, Viscoli C, Orasch C, et al. Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients. J infect. 2014;68:321–31.CrossRefGoogle Scholar
  17. Perez F, Adachi J, Bonomo RA. Antibiotic-resistant gram-negative bacterial infections in patients with cancer. Clin Infect Dis. 2014;59(Suppl 5):S335–9.CrossRefGoogle Scholar
  18. Satlin MJ, Walsh TJ. Multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus: three major threats to hematopoietic stem cell transplant recipients. Transpl Infect Dis. 2017;19:e12762. Epub 2017 Oct 25.CrossRefGoogle Scholar
  19. Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20(Suppl 1):1–55.CrossRefGoogle Scholar
  20. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. Preface. Bone Marrow Transplant. 2009;44:453–5.CrossRefGoogle Scholar
  21. Trecarichi EM, Pagano L, Candoni A, et al. Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey. Clin Microbiol Infect. 2015;21:337–43.CrossRefGoogle Scholar
  22. Vardakas KZ, Tansarli GS, Bliziotis IA, et al. Beta-lactam plus aminoglycoside or fluoroquinolone combination versus beta-lactam monotherapy for Pseudomonas aeruginosa infections: a meta-analysis. Int J Antimicrob Agents. 2013;41:301–10.CrossRefGoogle Scholar
  23. Weisser M, Theilacker C, Tschudin Sutter S, et al. Secular trends of bloodstream infections during neutropenia in 15 181 haematopoietic stem cell transplants: 13-year results from a European multicentre surveillance study (ONKO-KISS). Clin Microbiol Infect. 2017;23:854–9.CrossRefGoogle Scholar

Copyright information

© EBMT and the Author(s) 2019

Open Access  This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Pediatric Infectious Diseases, Hadassah Medical CenterHebrew UniversityJerusalemIsrael

Personalised recommendations