title: Gram-negative bacteraemia (GNB) after 428 unrelated donor bone marrow transplants (UD-BMT): risk factors, prophylaxis, therapy and outcome.
abstract: Gram-negative infection is an important cause of morbidity and mortality after unrelated donor-bone marrow transplantation (UD-BMT). We performed a retrospective case-control study to examine the risk factors, prophylaxis, therapy and outcome of Gram-negative bacteraemia (GNB) in 428 patients undergoing UD-BMT. The incidence of GNB was 3.6% in children and 19% in adults. Of the adults, 11% developed GNB >60 days post UD-BMT. Predisposing risk factors for GNB included 'high-risk' disease status, chronic graft-versus-host disease and use of systemic steroids. Fever, a raised C-reactive protein (CRP) and hypotension were common findings at presentation. Patients were routinely given prophylactic ciprofloxacin: resistance to this antibiotic was seen in 33% of isolates. We identified an age-matched control group undergoing UD-BMT over the same time period as the study group. Gram-positive bacteraemia was significantly more common in cases than controls. Mortality from GNB was 17% in children and 24% in adults. We conclude that GNB is a common complication of UD-BMT with a high associated mortality. Patients should be educated further to present rapidly with symptoms suggestive of infection.
authors.affiliation: Adult and Paediatric Bone Marrow Transplant Unit, Bristol Royal Children's Hospital, Bristol, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Mitchell
authors.forename: P
authors.initials: P
authors.lastname: Derrington
authors.forename: P
authors.initials: P
authors.lastname: Turner
authors.forename: L P
authors.initials: LP
authors.lastname: Hunt
authors.forename: A
authors.initials: A
authors.lastname: Oakhill
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000209:etiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002939:Ciprofloxacin