Prevalence of Sepsis in Hematopoietic Stem Cell Transplant Recipients: Organism-Specific Analysis

Introduction:

Patients who undergo hematopoietic stem cell transplants are at a high risk of infection. With the emergence of multidrug-resistant organisms (MDR), the prevalence of sepsis has increased. The most common infections are bloodstream infections, pneumonia, and gastrointestinal infections. Understanding the organisms commonly causing infections can help guide management and decrease mortality and morbidity.

Objective:

In this study, we aimed to analyze the prevalence of sepsis and the common organisms causing it, as well as hospital charges and the impact of sepsis on hematopoietic stem cell transplant patients.

Methods:

We used the National Inpatient Sample Database to find hospitalized patients from 2016 to 2020. We used the ICD-10 codes to diagnose patients undergoing hematopoietic stem cell transplants. The patients were then divided into two groups: those who developed sepsis and those who did not develop sepsis. In the sepsis group, we found the prevalence of organisms causing sepsis and its impact on hospital outcomes. Multivariate regression analysis was carried out after adjusting for appropriate confounders.

Results:

A total of 566,35 patients who underwent hematopoietic stem cell transplants were detected. Out of them, 0.3% (195) patients had MRSA sepsis, 0.2% (n=125) had staphylococcus sepsis, 1% (n=570) had Escherichia coli (E. coli) sepsis, 0.3% (b=185) had pseudomonas sepsis, 0.2% (n= 135) had enterococcus sepsis and 0.3% (n= 180) had sepsis by other gram-negative organisms. The mean age of the patients with MRSA infection was 51 years; staphylococcus sepsis was 48 years; with E coli sepsis was 53 years; with pseudomonas sepsis was 60 years; with enterococcus sepsis was 56 years; and other gram-negative organisms causing sepsis was 50 years.

All-Cause Mortality and Cost of Hospitalization:

The odds of mortality were highest in patients who had sepsis with enterococcus (11%, aOR 9.1 [95% CI: 2.6-35], p-value <0.01) and lowest in MRSA (2.5% of the patients, aOR 2.5 [95% CI 0.3-17], p-value 0.9), although this was not significant. Mortality in E coli group was 4% (p-value 0.1), E coli was 7.2% (p-value <0.001), pseudomonas was 10% (p-value <0.001), and other gram-negative organism group was 10 % (p-value <0.001). The cost of hospitalization was also increased in patients who developed sepsis as compared to those without sepsis (staphylococcal sepsis $530717 vs. $277 090; p-value 0.04, MRSA sepsis $463,200 vs $277,002; p-value 0.02, E coli sepsis $466,078 vs $275,717; p-value 0.005, pseudomonas sepsis $488,509 vs $276,935; p-value 0.01, enterococcus sepsis $$633,799 vs. $276,806; p-value 0.00, other gram-negative organism sepsis $613,014 vs. $276,554; p-value 0.00).

Outcomes:

Our analysis also showed an increased association with other complications in the sepsis group as compared to patients who did not have sepsis. Septic shock was noticed to be highest in the enterococcus group (in 33% of the patients, aOR 16 [95% CI: 6.4-39], p-value <0.001) and lowest in staphylococcus group (in 12% of the patients, aOR 5.3 [95% CI: 1.5-17], p-value <0.001). Acute kidney injury was highest in MRSA group (51% of the patients, aOR 8.8 [95% CI: 4.2-18], p-value 0.00) and lowest in gram negative group (22% of the patients, aOR 1.9 [95% CI: 0.8-4.3], p-value 0.00). Prevalence of venous thromboembolism (VTE) was also found to be highest in MRSA group (12% of the patients, aOR 5.2 [95% CI:2-13], p-value 0.01) as well as Staphylococcus group (12% of patients had VTE, aOR 4.6 [95% CI: 1.3-16], p-value 0.01) and was lowest in E coli group (4.2% of the patients, aOR 2 [95% CI: 0.4-8], p-value 0.4).

Conclusion:

Our study shows sepsis significantly impacts the outcomes of patients who undergo hematopoietic stem cell transplants. Hence, there is a need for early detection of sepsis, targeted infection control, and timely treatment to improve the outcomes.

Anwer:BMS: Consultancy.