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Bacterial pneumonia in recipients of bone marrow transplantation. A five-year prospective study
1Institute of Pulmonology, Computer Unit, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Abstract:
Bacterial pneumonia as an important complication of bone marrow transplantation (BMT) has not been subjected to comprehensive analysis. Two hundred fifty-five consecutive allogeneic and autologous BMT recipients, ranging in age from 1 month to 53 years, were prospectively followed for 3 days to 3 years (median, 108 days) for development of bacterial pneumonia. Etiology, place acquired, chest radiography, and outcome were recorded and the association between bacterial pneumonia and demographic and clinical variables was analyzed. Thirty-seven (15%) patients experienced 52 episodes of bacterial pneumonia: onset of 13 episodes occurred within 30 days after transplantation, 10 episodes occurred on days +31 to +100, and 29 episodes occurred thereafter. Bacterial pneumonia was the terminal event or contributed to fatal outcome in 8 patients (22% of bacterial pneumonia cases, 3% total study population). Mortality due to hospital-acquired pneumonia (6/21) was significantly higher than (P = 0.03). Bacterial pathogens were identified in 27 (52%) episodes. During the first 100 days after BMT, hospital-acquired Gram-negative bacteria predominated, caused mainly by Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter lwoffi, and Enterobacter cloacae. After day +100, community-acquired, Gram-positive bacteria predominated, particularly Streptococcus pneumoniae. Haemophilus influenzae occurred periodically. Considering all episodes, significant association was found between bacterial pneumonia and veno-occlusive disease (VOD) (P < 0.01) and chronic graft-versus-host disease (GVHD) (P < 0.02). For culture-positive episodes, the association between bacterial pneumonia and VOD was significant (P < 0.001) and borderline for acute GVHD (P = 0.07). It is concluded that VOD and GVHD are positively associated with post-BMT bacterial pneumonia. Its incidence, etiology, risk factors, and outcome are important considerations in its prevention and treatment.
Insights
Bacterial pneumonia is a significant complication following bone marrow transplantation (BMT), with hospital-acquired infections posing a higher mortality risk. Veno-occlusive disease and graft-versus-host disease are linked to increased pneumonia incidence post-BMT.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Bacterial pneumonia is a serious complication after bone marrow transplantation (BMT).
- Comprehensive analysis of bacterial pneumonia post-BMT, including etiology, acquisition, and outcomes, is limited.
- Understanding risk factors is crucial for prevention and treatment strategies.
Purpose of the Study:
- To comprehensively analyze the incidence, etiology, risk factors, and outcomes of bacterial pneumonia in bone marrow transplant recipients.
- To investigate the association between bacterial pneumonia and demographic/clinical variables, including veno-occlusive disease (VOD) and graft-versus-host disease (GVHD).
Main Methods:
- Prospective follow-up of 255 allogeneic and autologous BMT recipients.
- Recording of pneumonia etiology, acquisition site, radiographic findings, and patient outcomes.
- Statistical analysis to determine associations between bacterial pneumonia and clinical variables.
Main Results:
- 37 patients (15%) experienced 52 episodes of bacterial pneumonia.
- Hospital-acquired pneumonia had significantly higher mortality (P = 0.03).
- Gram-negative bacteria predominated early post-BMT, shifting to Gram-positive bacteria later.
- Veno-occlusive disease (VOD) and chronic graft-versus-host disease (GVHD) were significantly associated with bacterial pneumonia (P < 0.01, P < 0.02).
Conclusions:
- Bacterial pneumonia is a significant complication post-BMT with considerable mortality.
- Veno-occlusive disease and graft-versus-host disease are key risk factors for post-BMT bacterial pneumonia.
- Further research into prevention and treatment strategies for bacterial pneumonia in BMT patients is warranted.