Longitudinal Study of Bacterial, Viral, and Fungal Infections in Adult Recipients of Bone Marrow Transplants

Abstract

The epidemiology of infections was studied in a retrospective cohort of 446 recipients of bone marrow transplants (BMTs; 92 of which were allogeneic and 354 of which were autologous) during 1993--1996. Infections that were microbiologically documented in 274 recipients included bacteremia, urinary tract infections, cytomegalovirus viremia, fungemia, invasive aspergillosis, and catheter-related infections. During the period of neutropenia, no differences were found between recipients of allogeneic BMTs and recipients of autologous BMTs with regard to the incidence and the nature of infection. After patients underwent engraftment, bacteremia, cytomegalovirus viremia, and invasive aspergillosis were significantly more common in recipients of allogeneic BMTs than in recipients of autologous BMTs. Deaths caused by infection were uncommon and were mainly the result of invasive aspergillosis. Therefore, empirical antimicrobial therapy should be the same for recipients of both allogeneic and autologous BMTs during the period of neutropenia; after engraftment, more attention should be paid to the risk of infection in allogeneic BMT recipients, particularly with regard to detection and prevention of invasive aspergillosis.

Infections among allogeneic bone marrow transplant recipients in India

“…16,17 Studies from Asian countries like Israel have observed an increasing incidence of fungal isolates from BMT units 18 similar to the data from our center (19.7%). Infections due to Candida infections have decreased over the years probably due to the early institution of fluconazole for the treatment of febrile neutropenia.…”

High rate of discordance between clinical and autopsy diagnoses in blood and marrow transplantation

“…3,6,8,18,23 The majority of disagreements related to difficulties in the evaluation of relapsed or persistent disease, GVHD and infectious diseases. Infection is a major cause of death in BMT patients 11,[23][24][25][26][27][28] and accounts for most of the major disagreements (63%) in our study.…”

Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

“…However, in this study, such an influence of contaminants is less likely since (1) our definition of BSI with common skin contaminants was rigorous (at least two positive consecutive cultures or two positive cultures within 72 h of one another) and in accordance with that used by other investigators; 1,4,6,16,[38][39][40][41][42][43] (2) the cultures were obtained in response to an indication of infection as opposed to carried out for surveillance; and (3) the common isolation of coagulase-negative staphylococcal from the blood is consistent with other studies. 2,6,44,45 It is more likely that the high proportion of coagulase-negative staphylococcal BSI was due to several factors including the presence of indwelling central venous catheters in virtually all of the patients in the early post-HSCT phase and the universal use of prophylaxis with fluoroquinolones. Finally, the group of patients undergoing reduced intensity HSCT was small, comprising 5% of the total cohort.…”

“…1,2 It has been observed to occur in 13-60% of HSCT recipients. 1,[3][4][5][6][7][8][9][10] The differences in findings of these studies is likely due to factors such as different study designs, study populations, conditioning regimens and prophylactic antibiotic protocols.…”