Early infections in patients undergoing bone marrow or blood stem cell transplantation – a 7 year single centre investigation of 409 cases

Abstract

Summary:Infections are a major cause of morbidity and mortality in patients undergoing high-dose therapy and subsequent autologous or allogeneic haemopoietic stem cell transplantation, despite the change from topical to systemic anti-infection prophylaxis and the introduction of growth factors and new antimicrobial drugs. We report our single centre experience with data from 409 patients treated at our unit from its opening in 1990 until May 1997. Three hundred and seventy-eight patients were transplanted for the first time, 12 patients were retransplanted or boosted and 19 patients were readmitted for miscellaneous reasons. 245 patients were allografted and 157 autografted. Antimicrobial prophylaxis was mainly quinolones, fluconazole plus amphotericin-B orally, aciclovir, and TMP/SMX or pentamidine. Three hundred and nineteen (78%) developed fever of significantly longer duration in the allogeneic setting with anti-CMV seropositivity. The most frequent infection was fever of unknown origin (50.6%), followed by septicaemia (12.5%) and pneumonia (11.0%). Pathogens isolated in 24.6% of the infections were mostly grampositive bacteria (57.9%), followed by non-fermenting rods (11.2%), Aspergillus spp. and Candida spp. Systemic infection with these pathogens is associated with a poor prognosis. Antimycotic prophylaxis and the therapy must be improved.

Defective Phagocytosis and Clearance of Pseudomonas aeruginosa in the Lung Following Bone Marrow Transplantation

“…Recipients of BMT are often plagued with life-threatening infections. Infectious complications occur in 60 -80% of BMT recipients, usually occur within the first several weeks after BMT, and account for over half of transplant-related mortality (1,2). The lung is a common target of infection after BMT, and bacterial pneumonias with Gram-negative rods and Gram-positive cocci predominate (1,3,4).…”

“…The lung is a common target of infection after BMT, and bacterial pneumonias with Gram-negative rods and Gram-positive cocci predominate (1,3,4). The reported incidence of infectious pneumonia in BMT recipients varies from 11-30% (2,5,6). Associated mortality has been estimated at ϳ22% in one study, with nosocomial pathogens leading to a significantly worse outcome (5).…”

Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence

“…The majority of early infectious complications in our study consisted of bacterial infections, with no difference in incidence between MR and MU/MM all0-SCT recipients. As in other reports, 8,10,19 Gram-positive bacteria, especially coagulase-negative staphylococci, were the predominant pathogens cultured in cases of microbiologically documented infections. With our prophylactic regimen of cephalotin, we found a low incidence of viridans streptococci compared to other reports, 8,10 but awareness of infection with resistant strains of viridans streptococci is necessary.…”

“…As in other reports, 8,10,19 Gram-positive bacteria, especially coagulase-negative staphylococci, were the predominant pathogens cultured in cases of microbiologically documented infections. With our prophylactic regimen of cephalotin, we found a low incidence of viridans streptococci compared to other reports, 8,10 but awareness of infection with resistant strains of viridans streptococci is necessary. Only four infections were caused by Gram-negative bacteria, reflecting the efficacy of prophylaxis with ciprofloxacin, yet one E. coli strain was resistant to ciprofloxacin.…”

“…Moreover, MU/MM allograft patients had received a different conditioning regimen, including ATG. Other studies have also reported positive recipient CMV serology, 10 use of a T celldepleted allograft 18 and occurrence of aGVHD 3 as risk factors for early infections, primarily because these factors may have an influence on the duration of neutropenia. However, we found no difference in these risk factors between MR and MU/MM allo-SCT recipients.…”