title: Usefulness of daily surveillance blood cultures in allogeneic hematopoietic stem cell transplant recipients on steroids: a 1-year prospective study.
abstract: BACKGROUND
  Bloodstream infections (BSI) are frequent and potentially severe complications in allogeneic hematopoietic stem cell transplant (AHSCT) recipients. In patients on steroids, surveillance blood cultures (SBCs) are routinely performed to detect asymptomatic BSI but their usefulness remains controversial.
  
  
  METHODS
  We performed a 1-year, observational, prospective, single-center study to assess the utility of daily SBCs in AHSCT recipients on steroids and a case-control study to identify risk factors associated with positive SBCs. All blood cultures (BCs) obtained from adults hospitalized in the HSCT unit were prospectively studied throughout 1 year. Characteristics, treatments, and outcome of patients were retrieved from medical charts.
  
  
  RESULTS
  A total of 3594 BCs were obtained in 177 patients, including 1450 SBCs in 82 AHSCT recipients on steroids. In 33 patients, 103 SBCs (7%) were positive. Low-virulence bacteria were identified in 74% of episodes. When analyzing first episode of positive SBCs (28 patients), 6 (21%) true BSI were identified.
  
  
  CONCLUSIONS
  Patients with positive SBCs were receiving antibiotic treatment less frequently at the time of SBCs (P < 0.001) and had more frequently BCs obtained through central venous access (P < 0.04) when compared to patients with negative SBCs. Daily SBCs in AHSCT recipients on steroids only rarely identify BSI and clear benefit for patients could not be demonstrated.
authors.affiliation: Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Colombier
authors.affiliation: Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lafaurie
authors.affiliation: Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.
authors.forename: F S
authors.initials: FS
authors.lastname: de Fontbrune
authors.affiliation: Biostatistic Unit, Hôpital Saint-Louis, AP-HP, Inserm 1153 ECSTRA Team, Université Paris 7 Diderot, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Donay
authors.affiliation: Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France.|Sorbonne Paris Cité, Université Paris Diderot, Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Pons
authors.affiliation: Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.|Sorbonne Paris Cité, Université Paris Diderot, Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Molina
authors.affiliation: Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.|Inserm UMR 1160, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socie
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D058345:Asymptomatic Infections / Q000628:therapy*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D000071997:Blood Culture / Q000379:methods*; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids
keywords: allogeneic hematopoietic stem cell transplantation; bloodstream infection; steroids; surveillance blood cultures