Mossad S B, Longworth D L, Goormastic M, Serkey J M, Keys T F, Bolwell B J
Department of Infectious Diseases, Cleveland Clinic Foundation, Ohio 44195, USA.
Bone Marrow Transplant. 1996 Aug;18(2):265-71.
The objective of this study was to define the incidence, type and timing of early infectious complications, occurring within the first 30 days, in autologous bone marrow transplant (autoBMT) recipients over a 45-month period, and in addition to assess the effects of growth factors and primed peripheral blood progenitor cells on the rate of infectious complications. The paper describes a retrospective and observational study, carried out at the bone marrow transplantation unit at a tertiary referral center. The subjects were two hundred and nineteen patients who underwent autologous bone marrow transplantation for a variety of indications from April 1989 to December 1992. The median duration of neutropenia after autologous bone marrow transplantation was 12 days. There was a direct correlation between the duration of neutropenia and the incidence of infectious complications. The overall incidence of infections and isolated febrile episodes was 35%. Septicemia occurred in 7.8% of patients, pneumonia in 2.7%, skin infection in 1.8%, other infections in 2.7% and isolated febrile episodes in 20.1%. Viridans streptococci were the most common cause of septicemia. Invasive fungal infections occurred in only 2.3% of patients. There were no documented viral infections. The use of growth factors and primed peripheral blood progenitor cells was associated with a shorter duration of neutropenia; a decrease in the overall incidence of infections, particularly septicemia and fungal infections; a shorter length of stay in the hospital and a lower mortality rate in the first 30 days after transplantation. We found a lower incidence of bacterial and fungal infections compared to previous studies. The critical factor associated with the occurrence of any early infection was the duration of neutropenia, which was significantly shortened by the use of growth factors and peripheral blood progenitor cells. Septicemia was uncommon in our population and viridans streptococci were the most common bloodstream isolates.
本研究的目的是确定在45个月期间，自体骨髓移植（autoBMT）受者在最初30天内发生的早期感染并发症的发生率、类型和时间，并评估生长因子和预处理外周血祖细胞对感染并发症发生率的影响。本文描述了一项在三级转诊中心的骨髓移植科进行的回顾性观察研究。研究对象为1989年4月至1992年12月期间因各种适应证接受自体骨髓移植的219例患者。自体骨髓移植后中性粒细胞减少的中位持续时间为12天。中性粒细胞减少的持续时间与感染并发症的发生率直接相关。感染和单纯发热发作的总发生率为35%。7.8%的患者发生败血症，2.7%发生肺炎，1.8%发生皮肤感染，2.7%发生其他感染，20.1%发生单纯发热发作。草绿色链球菌是败血症最常见的病因。侵袭性真菌感染仅发生在2.3%的患者中。无病毒感染的记录。生长因子和预处理外周血祖细胞的使用与中性粒细胞减少持续时间缩短、感染总发生率降低（尤其是败血症和真菌感染）、住院时间缩短以及移植后最初30天内死亡率降低相关。我们发现与先前研究相比，细菌和真菌感染的发生率较低。与任何早期感染发生相关的关键因素是中性粒细胞减少的持续时间，而生长因子和外周血祖细胞的使用可显著缩短该时间。败血症在我们研究人群中并不常见，草绿色链球菌是最常见的血流分离菌。
