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[Infections following bone marrow transplantation]
P Ljungman1, J Andersson, E Sparrelid
1Inst för invärtesmedicin, Karolinska Institutet, Huddinge sjukhus.
Abstract:
Recent years have witnessed a reduction in the frequency of infectious complications both in allogeneic and in autologous bone marrow transplantation (BMT). With a frequency of 30-40 percent, septicaemia is the predominant problem during the aplastic phase. Owing to the introduction of prophylaxis with quinolones, there has been a shift in the aetiological spectrum toward Gram-positive infections, and Gram-negative infections now account for less than 10 percent of all cases. In turn, this has been accompanied by reduced mortality. Early institution of treatment based on viraemia diagnosis has radically reduced the substantial morbidity and mortality formerly due to cytomegalovirus infection during the first three months after BMT. Antibiotic prophylactic treatment for Pneumocystis carinii infection during the first year, and against pneumococcal infections thereafter, has also been highly successful. The remaining problems are the diagnosis and treatment of invasive fungal infections and the increased susceptibility to infection among those who develop graft-versus-host disease.
Insights
Infectious complications after bone marrow transplantation (BMT) have decreased due to prophylactic antibiotics and early diagnosis. Key challenges remain invasive fungal infections and managing infections in graft-versus-host disease patients.
Area of Science:
- Hematology
- Infectious Diseases
- Transplantation Medicine
Context:
- Bone marrow transplantation (BMT) is a critical treatment for various hematologic and oncologic conditions.
- Historically, infectious complications posed a significant threat to BMT recipients, leading to high morbidity and mortality.
- Recent advancements in prophylaxis and diagnostics have begun to mitigate these risks.
Purpose:
- To review the evolving landscape of infectious complications following allogeneic and autologous bone marrow transplantation.
- To highlight the impact of prophylactic strategies and early diagnostic interventions on patient outcomes.
- To identify persistent challenges in managing infections post-BMT.
Summary:
- Septicemia remains the most frequent complication (30-40%) during the aplastic phase of BMT.
- Prophylaxis with quinolones has shifted the spectrum towards Gram-positive infections, reducing Gram-negative cases (<10%) and overall mortality.
- Early diagnosis and treatment of cytomegalovirus (CMV) viremia, alongside prophylactic antibiotics for Pneumocystis carinii and pneumococcal infections, have significantly improved outcomes.
- Persistent challenges include diagnosing and treating invasive fungal infections and managing infections in patients with graft-versus-host disease.
Impact:
- Reduced mortality and morbidity associated with infectious complications post-BMT.
- Shift in the etiological profile of infections, necessitating updated treatment guidelines.
- Improved survival rates and quality of life for BMT recipients.
- Identification of critical areas for future research and clinical intervention, particularly fungal infections and GvHD-related complications.