title: A study of incidence and characteristics of infections in 476 patients from a single center undergoing autologous blood stem cell transplantation.
abstract: Infectious complications are a major cause of morbidity and mortality in patients who undergo autologous stem cell transplantation (ASCT). We examined 476 patients with hematologic malignancies (401) or solid tumors (75) who underwent ASCT between February 1990 and May 2005. Anti-infectious prophylaxis consisted of different combinations of ciprofloxacin, cotrimoxazole, fluconazole, aerosolized amphotericin B, acyclovir, and intravenous immunoglobulins. Overall, 454 patients (95%) developed fever in the first 60 days after ASCT. In the majority of patients, initial antibiotic therapy consisted of broad-spectrum beta-lactamic with or without amikacin. A glycopeptide was administered as initial therapy in 86 cases. Overall, there were 132 (29%) clinically documented infections (37 pneumonias), 79 (17%) microbiologically documented infections (65 bacteremias), and 243 (54%) fevers of unknown origin. Coagulase-negative staphylococci (18, 25%) and E coli (18, 25%) were the organisms most frequently isolated. The pattern of infection did not change throughout the study except for a significantly higher incidence of bacteremia due to gram-positive bacteria in the first 5 years of the study. Infection-related mortality was 5% (21 cases), with pneumonia the most frequent cause of death. ASCT should be considered a low-risk procedure, although new therapeutic approaches for patients developing severe respiratory infections are still needed.
authors: Hematology Service, University Hospital La Fe, Valencia, Spain.
authors: Noemí
authors: N
authors: Puig
authors: Javier
authors: J
authors: de la Rubia
authors: Isidro
authors: I
authors: Jarque
authors: Miguel
authors: M
authors: Salavert
authors: Pau
authors: P
authors: Montesinos
authors: Jaime
authors: J
authors: Sanz
authors: Guillermo
authors: G
authors: Martín
authors: Guillermo
authors: G
authors: Sanz
authors: Susana
authors: S
authors: Cantero
authors: Ignacio
authors: I
authors: Lorenzo
authors: Miguel A
authors: MA
authors: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia; D005260:Female; D005334:Fever; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced / Q000188:drug therapy / Q000401:mortality; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D011292:Premedication; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D000890:Anti-Infective Agents; D000970:Antineoplastic Agents