Colombier M-A, Lafaurie M, de Fontbrune F S, Resche-Rigon M, Donay J-L, Pons J-L, Molina J-M, Socie G
Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.
Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.
Transpl Infect Dis. 2016 Aug;18(4):504-11. doi: 10.1111/tid.12552. Epub 2016 Aug 1.
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.
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.
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.
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.
血流感染（BSI）是异基因造血干细胞移植（AHSCT）受者常见且可能严重的并发症。对于使用类固醇的患者，常规进行监测血培养（SBC）以检测无症状的BSI，但其效用仍存在争议。
我们进行了一项为期1年的观察性、前瞻性、单中心研究，以评估每日SBC在使用类固醇的AHSCT受者中的效用，并进行了一项病例对照研究以确定与SBC阳性相关的危险因素。对HSCT病房住院的成人在整个1年中获得的所有血培养（BC）进行前瞻性研究。从病历中检索患者的特征、治疗和结局。
177例患者共获得3594份BC，其中82例使用类固醇的AHSCT受者中有1450份SBC。33例患者中，103份SBC（7%）呈阳性。74%的感染事件中鉴定出低毒力细菌。在分析SBC首次阳性事件（28例患者）时，鉴定出6例（2比例为21%）真正的BSI。
与SBC阴性的患者相比，SBC阳性的患者在进行SBC时接受抗生素治疗的频率较低（P<0.001），且通过中心静脉通路获取BC的频率更高（P<0.04）。在使用类固醇的AHSCT受者中每日进行SBC仅很少能识别出BSI，且未证明对患者有明显益处。 04)。在使用类固醇的AHSCT受者中每日进行SBC仅很少能识别出BSI，且未证明对患者有明显益处。
