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Bacteriological infections during the first hundred days of allogenic bone marrow transplantation--experience from
Kanjaksha Ghosh1, A K Shenoy, Zahra Al-Mahrooqi
1Department of Haematology and Microbiology, College of Medicine, Sultan Qaboos University Hospital, Muscat.
Background:
Allogeneic bone marrow transplantation (ABMT) produces severe neutropenia lasting for days. During the first 100 days of allogeneic BMT bacterial infection is a major cause of mortality and morbidity. This is specially so till the patient engrafts with good neutrophil count (> 500/microl). Nature of bacterial infection and its sensitivity pattern partly reflects the patient's own flora, hospital flora and the antibiotic usage pattern in the hospital and the community. Hence although we know quite a lot about the nature of bacterial sepsis following ABMT quite well, its details vary from centre to centre. Hence the present study was undertaken at a newly developed BMT unit at Muscat, Oman.
Material And Methods:
Twenty one patients receiving allogeneic BMT for different indications were included in this study. These patients had blood culture from central and peripheral line whenever they developed fever > 38 degrees C lasting more than two hours and the relevant investigators like X-ray chest, USG, CRP levels, urine culture was done as and when required.
Results:
All patients in BMT unit developed fever > 38 degrees C during first 100 days but only nine patients showed positive blood culture on 12 occasions. 42% of these isolates were gram-positive organisms. No fungal infections were noticed. Twenty percent of the gram-negative isolates from adjoining pardiatric oncology ward were resistant to ciprofloxacin though this is a reserved drug in this hospital. One out of 21 BMT patient in the present study died due to sepsis with resistant Klebsiella organism. Imipenem as a single drug did not cover all the organisms isolated. Listeria monocytogenes was an unusual organism in our BMT patient.
Conclusion:
The present result of less than 5% mortality in the ABMT patients due to sepsis is excellent and this is related to early marrow recovery and efficient microbiological surveillance in this centre. Cautions should be exercised while using imipenem as a single antibiotic in ABMT situations. Though ciprofloxacin is a reserved drug in this hospital, increased incidence of resistance to this antibiotic probably represents its wide usage in the community.
