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[Infectious complications in bone marrow transplantation]
M T Gómez Casares1, M J Alsar, E Conde
1Servicios de Hematología, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander.
Background:
Initially, the aim of the present study was to evaluate the incidence and implicated organisms in the infections in patients receiving a bone marrow transplants (BMT).
Methods:
194 febrile episodes (FE) were evaluated in 115 patients having received a BMT between 1980 and 1987. The analysis was carried out at three different moments: during the period of most marked neutropenia (period I) to the 100th day after BMT (period II) and beyond the 100th day (period III).
Results:
The unequivocal confirmation that FE was infective was found in 62% of cases (confirmation was microbiological in 46% and clinical in 16%), while 31% of FE were considered as possible infections and the remaining 7% as doubtful infections. The causative organisms were bacteria (73%), viruses (10%), fungi (8%), and combinations of them (polymicrobial infections) (9%). Gram negative and Gram positive organisms were more common, respectively, in period I and in periods II and III (p = 0.02). Bacteremia was the commonest cause of confirmed infection. The overall mortality rate due to infection was 18%. There was a remarkably high mortality from pneumonia (54%) and a low mortality in patients with sepsis (6%) (p less than 0.0001). The number of FE was lower in patients with autografts than those with allografts (p = 0.08). 33% of the FE in patients with allografts were coincident with acute or chronic graft-versus-host disease, and in two thirds of them infections was confirmed.
Conclusions:
Infection represents a major complication of BMT. The different antimicrobial treatments used in association with bone marrow grafting allowed us to control most FEs. Pneumonia was the most severe infective localization and the leading cause of death. Mortality rate due to sepsis was small.
Insights
Infections are a major complication following bone marrow transplants (BMT), with bacteria being the most common cause. Pneumonia significantly increases mortality, while sepsis has a lower mortality rate.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Bone marrow transplantation (BMT) is associated with significant infectious complications.
- Evaluating the incidence and causative organisms of infections post-BMT is crucial for patient management.
Purpose of the Study:
- To determine the incidence and types of infections in patients undergoing bone marrow transplantation (BMT).
- To identify the organisms responsible for these infections and analyze their impact on patient outcomes.
Main Methods:
- Retrospective analysis of 194 febrile episodes in 115 BMT patients between 1980 and 1987.
- Categorization of febrile episodes into three periods: marked neutropenia, up to 100 days post-BMT, and beyond 100 days.
Main Results:
- Infections were confirmed in 62% of febrile episodes, with bacteria being the most frequent cause (73%).
- Pneumonia had a high mortality rate (54%), whereas sepsis had a low mortality rate (6%).
- Gram-negative bacteria predominated in early neutropenic periods, while Gram-positive bacteria were more common later.
Conclusions:
- Infection is a major BMT complication, necessitating effective antimicrobial strategies.
- Pneumonia is the most lethal infection post-BMT, while sepsis is less so.
- Graft-versus-host disease increases the risk of infection in allogeneic BMT recipients.