Gram-positive bacterial predomination in stem-cell transplant recipients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. S1; p. S370
• Main Authors: Stojanoski, Z, Cevreska, L, Genadieva-Stavrik, S, Pivkova, A, Ivanovski, N, Petrovska, M, Popovska, K, Georgievski, B
• Format: Journal Article
• Language: English
• Published: Nature Publishing Group 01-03-2009
• Subjects: Care and treatment; Complications and side effects; Gram-positive bacterial infections; Multiple myeloma; Patient outcomes; Prevention; Prognosis; Risk factors; Stem cells; Transplantation; North Macedonia
• ISSN: 0268-3369

Background: Infections are the most common complications of stem cells transplantation and chemotherapy induced neutropenia. Bacterial infections predominate during the early stage after transplantation. During this phase deep neutropenia and central venous catheter are the most important risk factors. Because of high rate of mortality due to gram-negative bacteria, prophylaxis against this microorganisms is mandatory, but this strategy offer gram-positive predomination in all sites of isolation. Despite low rate of mortality due to gram-positive bacteria, infections caused by Streptococcus today became a real problem. Material and methods: during a 8 years period we have performed 144 stem cells transplantation in 134 patients with different hematological malignancies(AML: 74; ALL: 6; CML: 7; CLL: 1, NHL: 13; Hodgkin Diseases: 16; Multiple myelomas: 24; Aplastic anaemia: 1;Myelofibrosis:1 Ewing Sarcoma: 1; Male:78 Female 66. Median age: 34 years (12-63). In order to monitoring local micro-flora we perform in all patient two times a week: blood-culture, sputum, urine-culture, and simples from central venous catheters. Cultures were performed using standard microbiological tools. Patients were treated in sterile room conditioned with HEPA filters, gram-negative prophylaxis with ciprofloxacine 1,0gr. per day, low bacterial diet. Results: Gram-positive cocci were predominantly isolated microorganisms (70%), then gram-negative bacteria (20%) and fungi (10%). The most frequent isolated bacteria was Staphylococcus coagulaza negative, from central venous catheter, while Streptococcus pneumonia was the most common bacteria isolated after day +12, predominantly from sputum. Meticillin resistant staphylococcus aureus (MRSA) was isolated in 10% from all gram positive bacteria. We have no Vancomicyn-resistant Enterococcus isolation. Conclusion: The epidemiological pattern of bacterial infection continues to evolve globally and locally at the institutional level, as do patterns of susceptibility and resistance. These trends are often associated with local treatment practices and have a significant effect on the nature of empirical antibiotic prophylaxis and therapy. In our center gram positive bacteria were isolated predominantly. Gram-positive prophylaxis is doctrinary used in some centers, but there is a problem with gram-positive resistance. Heptavalent pneumococcal vaccination may be reasonable choice.