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Published on: September 6, 2017
Rates of Microbiologically Diagnosed Infection and Pathogen Detection in Hematopoietic Stem Cell Transplant Patients
Lauren E Lee1, Alice E Barsoumian2, Alexander W Brown3
1Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234.
Abstract:
Infections remain a significant cause of mortality in hematopoietic stem cell transplant patients. Evaluations of causes of infection are often unrevealing, and at some sites, increasing rates of antimicrobial resistance have been noticed. We performed a retrospective analysis of infection rates and microbiologic testing yield, or percent of tests ordered to diagnose an infection, in the first 100 days of 30 allogeneic and 56 autologous stem cell transplants performed at San Antonio Military Medical Center from July 2011 to April 2014. Blood stream infections were diagnosed in 11.6% with a yield of 6%. Urinary tract infections were diagnosed in 2.3% with a yield of 3%. Clostridium difficile infections were diagnosed in 9.3% and testing yield was 6%. Incidence of respiratory viruses was 5.8% with 4 rhinoviruses/enteroviruses and 1 influenza virus identified. One Proteus mirabilis urinary isolate was an extended spectrum beta-lactamase producer. Five patients, 13% of allogeneic and 4% of autologous patients, died within the first 100 days post-transplantation. History of bacteremia was present in 60% of patients who died; however, only one died due to a microbiologically diagnosed infection. Improved diagnostic tests and methods are needed to increase yield of detection of infection in hematopoietic stem cell transplant patients.
Insights
Hematopoietic stem cell transplant patients face significant mortality from infections. This study found low microbiologic testing yield, highlighting the need for improved diagnostic methods to detect infections effectively.
Area of Science:
- Hematology
- Infectious Diseases
- Transplant Medicine
Background:
- Infections are a major cause of mortality in hematopoietic stem cell transplant (HSCT) recipients.
- Current methods for diagnosing infections in HSCT patients are often unrevealing.
- Antimicrobial resistance is an increasing concern in this vulnerable population.
Purpose of the Study:
- To analyze infection rates and the diagnostic yield of microbiologic testing within 100 days post-HSCT.
- To evaluate the effectiveness of current diagnostic strategies in identifying infections in HSCT patients.
Main Methods:
- Retrospective analysis of 30 allogeneic and 56 autologous HSCTs.
- Data collected from July 2011 to April 2014 at San Antonio Military Medical Center.
- Infection incidence and microbiologic testing yield were calculated.
Main Results:
- Bloodstream infections occurred in 11.6% (yield 6%), C. difficile in 9.3% (yield 6%), and respiratory viruses in 5.8%.
- Urinary tract infections were diagnosed in 2.3% (yield 3%).
- Five patients (13% allogeneic, 4% autologous) died within 100 days; only one death was linked to a microbiologically diagnosed infection.
Conclusions:
- Current microbiologic testing demonstrates a low yield in diagnosing infections in HSCT patients.
- There is a critical need for enhanced diagnostic tests and methods to improve infection detection.
- Improved diagnostics are essential to reduce mortality associated with infections post-HSCT.
