Aim: To describe the results of our strategies of prevention and treatment of infectious episodes during the neutropenic phase in HSCT Rc. Materials and methods : Total number of HSCT 417; number of patients (pts): 388; mean age: 33.9 (l-70); female: 256 (61%); hematological diseases: 247 (59%) solid tumors: 168 (40%) others 2; autologous (AU) 314 (75%) allogeneic (AL) 103 (25%): related 89 (85%, haploidentical 3-2%) non-related 14 (13%): bone marrow 10, umbilical cord blood 4. Mean engraftment days: 12.8 (0-48).Weekly surveillance cultures (WSC) were done: anterior nares swab: detection (dt) of methicillin-resistant (R) Staphylococcus sp, penicillin-R pneumococci and Aspergillus sp, mouthwash: dt of Candida sp, penicillin-R Streptococcus sp and stool: dt of multidrug-R aerobic gram-negative bacilli (AGNB), vancomycin-R Enterococcus and Candida sp. Routinely selective gastrointestinal decontamination for AGNB and antifungal prophylaxis were not done. Fluconazol (FLU) was used only in pts with non-C. krusei colonization detected by WSC. The initial empirical treatment for neutropenia and fever was ceftazidime plus amikacin. The febrile episodes were defined according to the guidelines of the Immunocompromised Host Society (1990). Results: 434 febrile episodes were detected: a) microbiologically defined infection 150 (34.5%): mono or polymicrobial bacteremia (B) 63, fungemia (F) 2; site of infection (SI) with B 37 and with F 3; bacterial SI without B 55 and fungal SI without F 6; b) clinically defined infection 90 (21%) and c) possible infection 194 (45 %); there were 11 pts without fever. Isolated microorganisms: 121 from 105 B and F,AGNB 52 (43%) with 46 (85%) Enterobacteriaceae, gram-positive cocci 53 (44%) with 41(77%) Staphylococcus sp, others 11(9%) and non-C. albicans 5 (4%). Nine pts had polymicrobial B and 7 more than one episode of B. The most frequent sites of infections with or without microbiological documentation were: urinary tract 51(25%), lungs 48 (23%) skin and soft tissues 31 (15%) anal 25 (12%) and catheter 21 (lO%).Two hundred thirty colonized pts (55%) received FLU prophylaxis and 136 pts (33%) empirical amphotericin B (desoxycholate 119, liposomal 28). Related transplant mortality was 10% (38/388), AU 8% (25/314), Al 13% (13003)and associated with documented infection 2% (7/388). Conclusions: (1) The use of FLU was avoided in 45 % of the pts, with the benefit of decreasing toxicity and costs. (2) All fungemias were by non-C.albicans, probably due to the previous overuse of FLU. (3) The same empirical antibiotic treatment has been used from the beginning of the program without emergence of R strains. (4) Mortality associated to documented infection was low, supporting our strategies of prevention and treatment.
Full conference title:
12th International Symposium on Infections in the Immunocompromised Host
- ISIIH 12th