Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 35; no. 6; pp. 577 - 582
• Main Authors: CHIZUKA, A, KAMI, M, TANOSAKI, R, GOMI, H, TAKAUE, Y, KANDA, Y, MURASHIGE, N, KISHI, Y, HAMAKI, T, KIM, S-W, HORI, A, KOJIMA, R, MORI, S-I
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-03-2005
• Subjects: Adolescent; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotics; Bacteremia; Bacteremia - diagnosis; Bacteremia - etiology; Bacteria - isolation & purification; Bacterial diseases; Bacterial sepsis; Bacteriological Techniques; Biological and medical sciences; Blood; Blood culture; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Catheterization, Central Venous; Catheters; Cell culture; Child; Corticoids; Corticosteroids; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Human bacterial diseases; Humans; Incidence; Infectious diseases; Inflammation; Male; Medical records; Medical sciences; Middle Aged; Pathogens; Patients; Prednisolone; Prednisolone - adverse effects; Prednisolone - therapeutic use; Pseudomonas aeruginosa; Retrospective Studies; Staphylococcus aureus; Stem cell transplantation; Stem cells; Steroids; Surveillance; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Human; Corticosteroid; Hematology; Stem cell; Hematopoietic cell; Homograft; Graft versus host reaction; Early stage; bloodstream infection; Bacteremia; Infection; Treatment; Surveillance; Bacteriosis; Graft; Diagnosis; Blood culture; graft-versus-host disease; allogeneic hematopoietic stem cell transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1704830

Bloodstream infection (BSI) is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-SCT). Corticosteroids mask inflammatory responses, delaying the initiation of antibiotics. We reviewed medical records of 69 allo-SCT patients who had been on >0.5 mg/kg prednisolone to investigate the efficacy of weekly surveillance blood cultures. A total of 36 patients (52%) had positive cultures, 25 definitive BSI and 11 probable BSI. Pathogens in definitive BSI were Staphylococcus epidermidis (n=7), S. aureus (n=4), Entrococcus faecalis (n=3), Pseudomonas aeruginosa (n=5), Acenitobacter lwoffii (n=4), and others (n=10). The median interval from the initiation of corticosteroids to the first positive cultures was 24 days (range, 1-70). At the first positive cultures, 15 patients with definitive BSI were afebrile. Four of them remained afebrile throughout the period of positive surveillance cultures. Patients with afebrile BSI tended to be older (P=0.063), and had in-dwelling central venous catheters less frequently than febrile patients (P<0.0001). Bloodstream pathogens were directly responsible for death in two patients with afebrile BSI. This study demonstrates that cortisosteroid frequently masks inflammatory reactions in allo-SCT recipients given conrticosteroids, and that surveillance blood culture is only diagnostic clue for 'occult' BSI.