Microbiologically documented infections following peripheral blood stem cell transplantation: single center experienceFevzi Altuntaş1, Orhan Yıldız2, Bülent Eser1, Emine Alp2, İsmail Sarı1, Mustafa Çetin1, Bülent Sümerkan3, Ali Ünal31Department Of Hematology And Bmt Unit, Erciyes University School Of Medicine, Kayseri, Turkey
2Department Of Infectious Diseases, Erciyes University School Of Medicine, Kayseri, Turkey
3Department Of Microbiology, Erciyes University School Of Medicine, Kayseri, Turkey
This study was performed to assess the incidence of infectious complications in patients undergoing autologous and allogeneic hematopoietic stem cell transplantation (HSCT). The characteristics of microbiologically documented infections in 114 consecutive patients undergoing HSCT (84 autologous, 30 allogeneic) were analyzed. Conditioning and the pre-engraftment period until one month was defined as the early period; the post-engraftment period until one year was defined as the late period. All patients received antibiotic prophylaxis and hematopoietic growth factors during neutropenia. Febrile patients received imipenem-cilastatin or cefepime plus amikacin or ceftazidime plus amikacin. A total of 117 episodes with microbiologically documented infections were seen 90 of 114 patients and 79% of the patients experienced at least one febrile episode during their post-transplant course. Of these episodes, 69 (59%) were in the early period and 48 (41%) were in the late period. In the early period, 38.8% of causative organisms were gram-positive, 51.5% were gramnegative and 7.7% were fungi. The most common pathogens were coagulase-negative Staphylococcus (CoNS) and E. coli in the early period. In the late period, 44.6% of causative organisms were gram-positive, 44.6% were gram-negative and 6.8% were fungi. CoNS and E. coli were also the most commonly isolated agents in this period. Resistance to methicillin was detected in 47.4% of S. aureus and 86.5% of CoNS isolates. The isolation rate was in accordance with previous reports; similar percentages of gram-positive and gram-negative isolates were found in patients undergoing HSCT in both periods. However, a remarkably low rate of viridans streptococci and fungi were observed. The spectrum of pathogens detected in these cases serves as the basis for recommendations on the choice of empiric antimicrobial treatment regimens. Therefore, studies reporting local microbiological findings are necessary. We suggest that local microbiologic surveillance should be known before empiric antimicrobial therapy is started in each institution. Keywords: Infection, Peripheral blood stem cell, Transplantation, Bacterial, Fungal.
Periferik kök hücre naklinde mikrobiyolojik kanıtlanmış infeksiyonlar: Tek merkez deneyimiFevzi Altuntaş1, Orhan Yıldız2, Bülent Eser1, Emine Alp2, İsmail Sarı1, Mustafa Çetin1, Bülent Sümerkan3, Ali Ünal31Department Of Hematology And Bmt Unit, Erciyes University School Of Medicine, Kayseri, Turkey
2Department Of Infectious Diseases, Erciyes University School Of Medicine, Kayseri, Turkey
3Department Of Microbiology, Erciyes University School Of Medicine, Kayseri, Turkey
Bu çalışma otolog ve allogeneik kök hücre nakli yapılan hastalarda infeksiyöz komplikasyonları değerlendirmek için yapılmıştır. Kök hücre nakli yapılan 1/4 hasta (84 otolog, 30 allogeneik) incelendi. Hazırlama ve birinci ayı içine alan pre-engrafman dönemi erken dönem, birinci yıla kadar engrafman sonrası dönem ise geç dönem olarak tanımlandı. Tüm hastalar nötropenik dönemde antibiyotik profilaksisi ve büyüme faktörü aldılar. Ateşli hastalar imipenem-silastatin veya sefepim + amikasin yada seftazidim + amikasin aldılar. Yüzondört olgunun 90`ında 117 mikrobiyolojik tanımlanmış infeksiyon atağı izlendi. Nakil sonrası dönemde hastaların %79`u en az bir febril epizod gösterdi. Bunların 69 (%59)`u erken, 48 (%41)`i geç dönemde idi. Erken dönemde etken mikroorganizmaların %38.8`i gram-pozitif %51.5`i gram-negatif ve %7.7`si mantar idi. Erken dönemde en sık rastlanan patojenler koagülaz-negatif stafilokok (KNS) ve E. coli idi. Geç dönemde ise etken mikroorganizmaların %44.6`sı gram-pozitif, %44.6`sı gram-negatif ve %6.8`i mantardı. Bu dönemde de KNS ve E. coli en sık rastlanan mikroorganizmalardı. S. aureus`ta %47.4, KNS de ise %86.5 metisilin direnci saptandı. Mikroorganizma izolasyon oranları daha önce bildirilenlerle benzerdir. Ancak viridans streptokok ve mantarlar nispeten düşük bulunmuştur. Bu olgulardaki etken spektrumun bilinmesi ampirik tedavi rejimlerinde antibiyotik seçiminde yol gösterici olmaktadır. Bu nedenle lokal sonuçların bildirimi önemlidir ve her kurumda ampirik antibiyotik başlamadan önce lokal mikrobiyolojik sürveyans sonuçlarının bilinmesi yararlı olur. Anahtar Kelimeler: İnfeksiyon, Periferik kök hücre nakli, Bakteriyel, Fungal.
Fevzi Altuntaş, Orhan Yıldız, Bülent Eser, Emine Alp, İsmail Sarı, Mustafa Çetin, Bülent Sümerkan, Ali Ünal. Microbiologically documented infections following peripheral blood stem cell transplantation: single center experience. Turk J Hematol. 2005; 22(3): 133-145
Corresponding Author: Fevzi Altuntaş, Türkiye |
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