Infections in Hematopoietic Stem Cell Transplantation Recipients in the Pre-Engraftment Period
DOI:
https://doi.org/10.15379/2408-9877.2015.02.01.03Keywords:
Stem cell transplantation, Infections, Fungal.Abstract
Introduction: The recipients of the hematopoietic stem cell transplantation (HSCT) are at increased risk of a variety of infections due to their immunocompromised state. The severity of the immunocompromise differs depending upon host, underlying disease, comorbidities, type of transplantation, conditioning regimen, and immunosuppressive drugs. Pre-engraftment period is attended by neutropenia, mucosal barrier disruption, broad spectrum antibiotic usage and invasive procedures like central lines.
Aim: We sought to evaluate the type and frequency of the infections in the pre-engraftment period in our transplant center.
Methods and Results: We reviewed 17 HSCT cases done in our center over 24 months from August, 2011 upto August, 2013 which included 11 autologous and 6 allogeneic HSCT cases. We found a total of 20 febrile neutropenic episodes with 12 bacterial and 6 fungal infections. Eighteen of the 73 cultures were positive (24.65%). Nine out of 17 patients (52.94%) had at least one culture positive. Eight out of 11 bacteria were ESBL producing (extended spectrum beta lactamase) and one organism was only sensitive to colistin. Only 2 of the 12 bacteria were gram positive (16.67%). Only one stool test was positive for Clostridium deficile. We had only one culture documented fungal infection (Aspergillus sinusitis) and 5 presumed Aspergillus infections.
Conclusion: The incidence of febrile neutropenia is similar to other centers in India and Western world, though the organisms are different. Gram negative bacteria continue to be the major threat to hematopoietic cell transplant recipients especially in the early post-transplant period in India.
References
Wingard JR. Advances in the management of infectious complications after bone marrow transplantation. Bone Marrow Transplant. 1990; 6 (6): 371.
Wingard JR. Prevention and treatment of bacterial and fungal infections. In: Forman, SJ, Blume, KG, Thomas, ED (Eds). Bone marrow transplantation Blackwell Scientific, Boston 1994. p .363-375.
Woo PC, Wong SS, Lum PN, Hui WT, Yuen KY. Cell-wall-deficient bacteria and culture-negative febrile episodes in bone-marrow-transplant recipients. Lancet. 2001; 357(9257): 675.
Wingard JR. Infections in allogeneic bone marrow transplant recipients. SeminOncol 1993;20(5 Suppl 6):80.
Prentice HG, Hann IM. Antiviral therapy in the immunocompromised patient. Br Med Bull 1985; 41(4): 367.
Slavin MA, Osborne B, Adams R, Levenstein MJ, Schoch HG, Feldman AR, Meyers JD, Bowden RA. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation a prospective, randomized, double-blind study. J Infect Dis. 1995; 171(6): 1545.
Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326(13): 845.
Wingard JR, Merz WG, Rinaldi MG, Miller CB, Karp JE, Saral R. Association of Torulopsisglabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients. Antimicrob Agents Chemother. 1993; 37(9): 1847.
Abi-Said D, Anaissie E, Uzun O, Raad I, Pinzcowski H, Vartivarian S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997; 24(6): 1122.
Bodey GP, Mardani M, Hanna HA, Boktour M, Abbas J, Girgawy E, et al. The epidemiology of Candida glabrata and Candida albicans fungemia in immunocompromised patients with cancer. Am J Med 2002; 112(5): 380.
Bodey GP, Mardani M, Hanna HA, Boktour M, Abbas J, Girgawy E, et al. The epidemiology of Candida glabrata and Candida albicansfungemia in immunocompromised patients with cancer. Am J Med 2002; 112(5): 380.
Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years' experience at a cancer center and implications for management. Blood 1997; 90(3): 999.
George B, Mathews V, Srivastava A, Chandy M. Infections among allogeneic bone marrow transplant recipients in India. Bone Marrow Transplantation (2004) 33, 311–315.
Gudiol C, Garcia-Vidal C, Arnan M, Sánchez-Ortega I, Patiño B, Duarte R, Carratalà J.Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients. Bone Marrow Transplant 2014 Mar 24. doi: 10.1038/bmt. 2014.37. [Epub ahead of print]
Kinnebrew MA, Lee YJ, Jenq RR, Lipuma L, Littmann ER, et al. Early Clostridium difficile Infection during Allogeneic Hematopoietic Stem Cell Transplantation. PLoS ONE 2014; 9(3): e90158
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