Pathology Queensland, Herston, Australia.
Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Herston, Australia.
Biol Blood Marrow Transplant. 2018 Jul;24(7):1360-1366. doi: 10.1016/j.bbmt.2018.02.025. Epub 2018 Mar 5.
The key complications of allogeneic bone marrow transplantation (BMT) remain graft-versus-host disease (GVHD) and opportunistic infection. We have analyzed the blood stream infections (BSIs) occurring between day -7 and day 100 in a cohort of 184 adult patients undergoing allogeneic BMT in our center. A total of 167 of the 184 patients (91%) had blood cultures collected, and 69 (38%) patients had a confirmed BSI. Enterobacteriaceae, Pseudomonas aeruginosa, Enterococcus spp., and viridans Streptococcus spp. were the most commonly isolated organisms. Gender, conditioning (myeloablative versus reduced intensity), and donor type (sibling versus unrelated) did not differ significantly between those with and without confirmed BSI. Elevated temperature (>38°C) at the time of culture collection was associated with an almost 2-fold increased likelihood of returning a positive blood culture. The absence of a BSI was associated with a significant improvement in overall survival at 2 years, due to a significant reduction in nonrelapse mortality predominantly unrelated to the primary BSI. The presence of a BSI before engraftment was associated with the dysregulation of IL-6 and IL-8. Our findings suggest that BSI early after BMT defines a group of high-risk patients with enhanced cytokine dysregulation and poor transplant outcome.
同种异体骨髓移植（BMT）的主要并发症仍然是移植物抗宿主病（GVHD）和机会性感染。我们分析了在我们中心接受同种异体 BMT 的 184 例成年患者队列中，在第-7 天至第 100 天之间发生的血流感染（BSI）。在 184 例患者中，共有 167 例（91%）采集了血培养，69 例（38%）患者确诊为 BSI。肠杆菌科、铜绿假单胞菌、肠球菌属和草绿色链球菌属是最常分离的病原体。有和没有确诊 BSI 的患者之间，性别、预处理（清髓性与强度降低性）和供者类型（同胞与非亲缘）没有显著差异。在采集培养物时体温升高（>38°C）与血培养阳性的可能性增加近 2 倍相关。没有 BSI 与 2 年总生存率的显著改善相关，这主要是由于非复发死亡率显著降低，而与原发性 BSI 无关。在植入前存在 BSI 与 IL-6 和 IL-8 的失调有关。我们的研究结果表明，BMT 后早期的 BSI 定义了一组高风险患者，这些患者存在细胞因子失调和较差的移植结果。
