OBJECTIVES: We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality. METHODS: Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT). RESULTS: The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7-9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5-7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6-7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4-1.1%). GNRB, especially MDR, was associated with increased mortality. Multivariate analysis revealed the following GNRB risk factors: (a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source; (b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited. (c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence. CONCLUSIONS: Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.

Anadolu Medical Center Hospital Kocaeli Turkey

Ankara University Faculty of Medicine Ankara Turkey

Azienda Ospedaliera Universitaria Careggi Firenze Italy

Bilim University Florence Nightingale Hospital Istanbul Turkey

Centre Leon Berard Lyon France

Charles University Hospital Pilsen Czech Republic

Clinica di Oncoematologia Pediatrica Padova Italy

Collegium Medicum Nicolaus Copernicus University Torun Bydgoszcz Poland

Department of Medical Oncology University Hospital Bern Bern Switzerland

Department of Medicine Hematology and Bone Marrow Transplant Unit University of Verona Verona Italy

Division of Infectious Diseases University of Genoa and Ospedale Policlinico San Martino Genova Italy

EBMT Data Office Leiden the Netherlands

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano Italy

Gazi University Faculty of Medicine Ankara Turkey

Hadassah University Hospital Jerusalem Israel

Hannover Medical School Hannover Germany

Hematology Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia Italy

Hospital de la Princesa Madrid Spain

Hospital dos Capuchos Lisboa Portugal

Hospital Santa Creu 1 Sant Pau Barcelona Spain

Hospital U Marqués de Valdecilla Santander Spain

ICO Hospital Universitari Germans Trias 1 Pujol Badalona Spain

Karolinska University Hospital Stockholm Sweden

National Research Center for Hematology Moscow Russian Federation

Ospedale Santa Maria della Misericordia Università di Perugia Perugia Italy

Pediatric Hematology Oncology Mother and Child Hospital Azienda Ospedaliera Universitaria Integrata Verona Verona Italy

Rambam Medical Center Haifa Israel

St Savvas Oncology Hospital Athens Greece

Sydney Children's Hospital Randwick Sydney Australia

Tel Aviv Sourasky Medical Center Sourasky Medical School Tel Aviv University Tel Aviv Israel

The Children's Hospital at Westmead Sydney Australia

The Medical University of Warsaw Warsaw Poland

Tor Vergata University Rome Italy

University of Medical Sciences Poznan Poland

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