Autologous Bone Marrow Transplantation - Blog Science Connections

Infectious Complications ofABMT 643
were isolated from blood: Pseudomonas aeruginosa 4, Klebsiella
pneumoniae 3, and Escherichia coli 1. The local sites of infection were the
Hickman catheter exit site in six patients and a paranasal sinus, a pilonidal
cyst, and a perirectal abscess in one each. Three of the Hickman catheter exit
site infections were associated with bacteremia.
Eighteen patients received trimethoprim-sulfamethoxazole (160/800
mg orally twice daily) as prophylaxis for bacterial infections (Table 2).
Seventy-five percent of the group who received this prophylactic regimen
developed bacterial infection compared to 40% of the group not receiving any
antibacterial prophylaxis (chi-square test, P= .036). There was no significant
difference in the incidence of fungal or viral infections between those who did
or did not receive trimethoprim-sulfamethoxazole.
Mucocutaneous fungal infections were common, occurring in 12 patients
(34.3%). Nine patients developed oropharyngeal candidiasis, two developed
Candida vaginitis, and one had perineal candidiasis. However, there were
only two cases of invasive fungal disease. Candida albicans was isolated
from the blood of one patient on the 31 st posttransplant day and C. parapsilosis
was isolated from the blood of a second patient on the third posttransplant
day. Additionally, seven patients with persistent unexplained fever were
given an empiric course of amphotericin B therapy, but none had defervescence
clearly attributable to systemic antifungal therapy.
A majority of patients (26/35) received oral nonabsorbable antifungal
agents as attempted prophylaxis for fungal infection. There was no significant
association between the use of this therapy and the development of mucocutaneous
fungal infection. The two episodes of fungemia developed in patients
who were receiving antifungal prophylaxis, but the incidence of this complication
is too low to allow meaningful analysis of the efficacy of prophylaxis.
There were 13 cases of mucocutaneous viral infection. Six patients had
culture-confirmed oropharyngeal herpes simplex virus infection. Six others
had clinically characteristic oropharyngeal herpes simplex virus infection and
one had localized herpes zoster. One initially seronegative patient developed
a high positive titer of antibody to cytomegalovirus and was therefore considered
to have had systemic cytomegalovirus infection.
Ten patients received antiviral prophylaxis with intravenous acyclovir (15
mg/kg/d). None of these patients developed evidence of mucocutaneous or
systemic herpetic infection. Twenty-five patients did not receive such prophylaxis,
and 13 of this group developed mucocutaneous herpes virus infection.
Thus acyclovir prophylaxis was shown to significantly reduce the incidence of
mucocutaneous herpes virus infection (chi-square test, P = .004).
Seven patients developed new pulmonary infiltrates in the posttransplantation
period. The infiltrate was not clearly attributable to an infection in
any of these cases. Two of the patients underwent bronchoscopy, but this did
not lead to definitive diagnosis in either. The new pulmonary infiltrate resolved
in four patients (all received broad-spectrum antibacterial therapy). The