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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 23; no. 6; pp. 589 - 597
• Main Authors: KRÜGER, W, RÜSSMANN, B, KABISCH, H, ERTTMANN, R, ZANDER, A. R, KRÖGER, N, SALOMON, C, EKOPF, N, ELSNER, H.-A, KAULFERS, P.-M, MACK, D, FUCHS, N, DÜRKEN, M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-03-1999
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antifungal Agents - therapeutic use; Antiinfectives and antibacterials; Antimicrobial agents; Aspergillus; Autografts; Bacteria; Bacterial diseases; Bacterial infections; Bacterial Infections - etiology; Bacterial Infections - prevention & control; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Candida; Child; Child, Preschool; Disease prevention; Disseminated infection; Female; Fever; Fluconazole; Gram-negative bacteria; Growth factors; Health risks; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Immunosuppressive agents; Infant; Infections; Male; Medical sciences; Middle Aged; Morbidity; Mycoses - etiology; Mycoses - prevention & control; Pathogens; Pentamidine; Pneumocystis Infections - etiology; Pneumocystis Infections - prevention & control; Prophylaxis; Quinolones; Rods; Septicemia; Stem cell transplantation; Stem cells; Therapy; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Treatment Outcome; Antineoplastic agent; Human; Cytomegalovirus; Candidiasis; Chemoprophylaxis; Mycosis; Herpesviridae; Homograft; Betaherpesvirinae; Infection; Virus; Prevention; Antibiotic; Antifungal agent; Autograft; Chemotherapy; Treatment; Viral disease; Aspergillosis; Bacteriosis; Graft; Antiviral; Complication; Myelosuppression
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1701614

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 gram-positive bacteria (57.9%), followed by non-fermenting rods (11.2%), Aspergillus spp. and Candida spp. (10.3%, each). Cumulative response rate to antimicrobial therapy was 66.9%. Infections were responsible for 62.5% (25/40) of deaths after transplantation. Predominant pathogens were Aspergillus spp. (11), Candida spp. (four), and Pseudomonas spp. (three). None of the patients died from gram-positive bacterial infection. The risk of dying from infection was 11.2% after allografting and 0.8% after autotransplantation. Infections remain a major risk for early death after allogeneic transplantation of haemopoietic stem cells. Infection with gram-negative bacteria can be prevented by quinolone prophylaxis. Predominant pathogens are Aspergillus spp. Candida spp. and nonfermenting rods. Systemic infection with these pathogens is associated with a poor prognosis. Antimycotic prophylaxis and the therapy must be improved.