1997 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Unexplained Fever

Summary:Infection remains an important cause of morbidity and mortality after bone marrow or stem cell transplantation. To evaluate the role of obtaining blood cultures for intermittent or persistent fever in neutropenic patients on antibiotic therapy, we performed a retrospective chart review of 196 consecutive patients admitted to the Bone Marrow Transplant Unit at the University of North Carolina Hospitals from 1995 to 1998. From the cohort of 196 patients, 154 patients developed neutropenic fever. The initial blood culture was positive in 16 of 145 patients during the first fever episode giving a prevalence of 11%. From the total of 109 patients that had blood cultures drawn after day 1 of fever, five patients had blood cultures positive for a pathogen, a prevalence of 4.6%. In only one patient, did blood cultures drawn after day 1 identify an organism not present on day 1 (prevalence 0.9%). After reviewing the results in the first 105 patients, we changed our timing of collection of blood cultures. Forty-nine patients were treated in this manner and we found that the mean number of blood cultures decreased from 9.2 to 4.7 per patient without a change in the frequency of infectious complications or length of hospitalization. Bone Marrow Transplantation (2000) 26, 533-538.

Section: Resultsmentioning

confidence: 99%

Utility of obtaining blood cultures in febrile neutropenic patients undergoing bone marrow transplantation

Serody

Berrey

Albritton

et al. 2000

“…Infections represent up to 63% of causes of death in standard allogeneic transplant recipients at the time of autopsy 8 . Theoretically, NMSCT could be associated with a reduced risk of infection because they cause less disruption of the gastrointestinal mucosa [9][10][11] and less severe neutropenia 9,12,13 .…”

Section: Introductionmentioning

confidence: 99%

Infections after allogeneic hematopoietic stem cell transplantation with a nonmyeloablative conditioning regimen

Frère

Baron

Bonnet

et al. 2006

Hematopoietic cell transplantation (HCT) following nonmyeloablative conditioning (NMSCT) could be associated with a reduced risk of infection compared to standard allogeneic HCT. We retrospectively analyzed incidence and risk factors of infection in 62 patients undergoing NMSCT with low-dose TBI +/-fludarabine and postgrafting CsA and MMF. The proportion of patients with any infection was 77%, but the majority of infectious events occurred beyond day 30. Donor other than sibling, older age, early disease and male gender were significant risk factors. The incidence of bacteraemia was 55% at 1 yr and the number of bacteraemic episodes was 0.9 per patient (0.08 before day 30). The risk of bacteraemia increased with older age and the use of a donor other than an HLAidentical sibling, but not with neutropenia. The incidence of infections other than bacteraemia correlated with the use of corticosteroids. The risk of CMV infection increased with high-risk CMV serology, and risk of CMV disease with high-risk CMV serology, older age, first transplantation and a diagnosis of lymphoma. In conclusion, after NMSCT, infections are not frequent in the first 30 days post-transplant but careful long-term monitoring is necessary thereafter.

“…[6][7][8][9][10] This diagnostic uncertainty has led to the widespread use of empirical antifungal therapy in patients with antibiotic-resistant neutropenic fever (ARNF). 11 However, fever is a nonspecific sign with multiple aetiologies and this strategy results in unnecessary treatment with potentially toxic and prohibitively expensive antifungal therapy.…”

mentioning

confidence: 99%

A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients

Jordanides

Allan

McLintock

et al. 2005

Summary:A blinded prospective study was performed to determine whether screening of whole blood using a real-time, panfungal polymerase chain reaction (PCR) technique could predict the development of invasive fungal infection (IFI) in immunocompromised haemato-oncology patients. In all, 78 patients (125 treatment episodes) were screened twice weekly by real-time panfungal PCR using LightCyclert technology. IFI was documented in 19 treatment episodes (five proven, three probable and 11 possible), and in 12, PCR was sequentially positive. PCR positivity occurred in: 4/5 proven; 2/3 probable; 6/11 possible; and 29/106 with no IFI. In 8/12 with IFI and sequentially positive PCR results, PCR positivity occurred before (median 19.5 days) and in 4/12 (median 10.5 days) after the initiation of empirical antifungal therapy. Based on sequential positive results for proven/probable IFI sensitivity, specificity, positive predictive value and negative predictive value were 75, 70, 15 and 98%, respectively. Real-time panfungal PCR is a sensitive tool for the early diagnosis of IFI in immunocompromised haemato-oncology patients. It may be most useful as a screening method in high-risk patients, either to direct early pre-emptive antifungal therapy or to determine when empirical antifungal therapy can be withheld in patients with antibiotic-resistant neutropenic fever. However, these strategies require further assessment in comparative clinical trials.