A study of incidence and characteristics of infections in 476 patients from a single center undergoing autologous blood stem cell transplantation

Autors de IIS La Fe

• 

  Javier De La Rubia Comos

  Autor

• Isidro Jarque Ramos

  Autor

• Miguel Salavert Lletí

  Autor

• Pau Montesinos Fernández

  Autor

• Jaime Sanz Caballer

  Autor

• Guillermo Sanz Santillana

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• 

  Miguel Ángel Sanz Alonso

  Autor

Autors aliens a IIS La Fe

• Puig, Noemi
• Martin, Guillermo
• Cantero, Susana

Grups d'Investigació

• Hematología y Hemoterapia

  

  Investigador Principal

  Javier De La Rubia Comos

Abstract

Infectious complications are a major cause of morbidity and mortality in patients who undergo autologous stem cell transplantation (ASCT). We examined 476 patients with hematologic malignancies (401) or solid tumors (75) who underwent ASCT between February 1990 and May 2005. Anti-infectious prophylaxis consisted of different combinations of ciprofloxacin, cotrimoxazole, fluconazole, aerosolized amphotericin B, acyclovir, and intravenous immunoglobulins. Overall, 454 patients (95%) developed fever in the first 60 days after ASCT In the majority of patients, initial antibiotic therapy consisted of broad-spectrum beta-lactamic with or without amikacin. A glycopeptide was administered as initial therapy in 86 cases. Overall, there were 132 (29%) clinically documented infections (37 pneumonias), 79 (17%) microbiologically documented infections (65 bacteremias), and 243 (54%) fevers of unknown origin. Coagulase-negative staphylococci (18,25%) and E coli (18,25%) were the organisms most frequently isolated. The pattern of infection did not change throughout the study except for a significantly higher incidence of bacteremia due to gram-positive bacteria in the first 5 years of the study. Infection-related mortality was 5% (21 cases), with pneumonia the most frequent cause of death. ASCT should be considered a low-risk procedure, although new therapeutic approaches for patients developing severe respiratory infections are still needed.

Keywords

• infectious complications; autologous stem cell transplantation; fluoroquinolones; chemoprophylaxis