engleski

Bloodstream infections following hematopoietic stem cell transplantation - a single center experience

Background: Knowledge of local microbiological epidemiology is essential for optimal management of infections following hematopoietic stem cell transplantation (HSCT). Aims: To evaluate incidence, timing and etiology of bloodstream infections (BSI) in patients treated with HSCT in a single institution. Patients & methods: 126 consecutive transplantations (Tx) were evaluated ; 101 autologous (80.2%) and 25 allogeneic (19.8%). Results: 36 BSI were identified at a median of 8 (range 1-256, SD 85) days post Tx. The majority of BSI were observed in the first month following HSCT, mostly (69.4% of all BSI) during the first 2 weeks. A total of 12 different bacterial species were identified. Gram- organisms were isolated in 52.8% of BSI, with P.aeruginosa accounting for 25% of all BSI and 45% of all Gram- BSI. Altogether P.aeruginosa was isolated in 9 patients and 4 of these isolates were resistant to carbapenems and sensitive to only one or two other antibiotic classes. Gram+ pathogens were responsible for 36.1% of BSI, with S.epidermidis being the most prevalent in this group (22.2% of all BSI, 61.5% of all Gram+ BSI). Fungemias represented 2.8% of all BSI, a trend towards higher incidence of fungemia in allogeneic HSCT patients was observed (x2, p=0.08). Conclusions: BSI were a frequent complication of HSCT, with highest incidence during chemotherapy induced mucosal damage and neutropenia. Despite fluoroquinolone prophylaxis, more Gram- than Gram+ BSI were identified. Empirical therapy in these immunosuppressed patients should inevitably include agents with strong antipseudomonal activity ; treatment of BSI caused by P.aeruginosa remains a challenge due to the multiple resistance of this pathogen in our institution.

bloodstream infections; hematopoietic stem cell transplantation; antimicrobial resistance

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