title: Early gram-positive bacteremia in BMT recipients: impact of three different approaches to antimicrobial prophylaxis.
abstract: Antimicrobial prophylaxis against gram-positive bacteremia (GPB) following BMT may prevent infections but promote antimicrobial resistance. In a sequential cohort study involving 289 consecutive BMT recipients we compared three protocols for prevention of GPB (vancomycin prophylaxis, penicillin/cefazolin prophylaxis, and no specific GPB prophylaxis) with respect to incidence of GPB, mortality, and vancomycin use. GPB was associated with increased mortality (27% vs 15%; P = 0.02), but contributed to only five of 52 deaths in the study population, and only one of 15 subjects with viridans streptococcal bacteremia developed fatal septic shock. Vancomycin prophylaxis reduced the incidence of GPB (11%) compared to penicillin/cefazolin (27%) or no prophylaxis (40%) (all P < 0.03), but did not significantly reduce mortality. The incidence of fungemia, gram-negative bacteremia, and infection-associated mortality was unaffected by GPB prophylaxis. Vancomycin use was substantially greater in the vancomycin prophylaxis group. We conclude that in comparison with vancomycin prophylaxis, BMT support regimens that do not include vancomycin prophylaxis allow reduced overall vancomycin use without an apparent increase in early post-BMT mortality, despite the greater associated frequency of GPB.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, USA.
authors.forename: C
authors.initials: C
authors.lastname: Arns da Cunha
authors.forename: D
authors.initials: D
authors.lastname: Weisdorf
authors.forename: X O
authors.initials: XO
authors.lastname: Shu
authors.forename: T
authors.initials: T
authors.lastname: DeFor
authors.forename: J D
authors.initials: JD
authors.lastname: Pastor
authors.forename: J R
authors.initials: JR
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016470:Bacteremia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002437:Cefazolin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage; D013290:Streptococcal Infections / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D014640:Vancomycin; D002437:Cefazolin