Profiles of infectious complications on the outcomes for the recipients of allogeneic hematopoietic stem cell transplantation

Rhee, Ji Young; Jang, Eun Hee; Kim, Seung Tai; Wi, Yu Mi; Son, Kyong Mok; Cheong, Hae Suk; Ki, Hyun Kyun; Oh, Won Sup; Kim, Ki Hyun; Jung, Chul Won; Kim, Won Seog; Park, Keunchil; Peck, Kyong Ran; Song, Jae Hoon

Abstract

BACKGROUND: We wanted to investigate the effect of infectious complications on the outcome of patients who received allogeneic hematopoietic stem cell transplantation (HSCT), and we determined the risk factors for predicting infectious complication and the mortality in allogeneic HSCT recipients.
METHODS
We enrolled all the patients who underwent allogeneic HSCT at Samsung Medical Center from February 1996 to October 2003.
RESULTS
A total of 139 patients were enrolled. A total of 450 infectious episodes were observed in 131 allogeneic recipients (90.8%). Infectious complications occurred in the allogeneic recipients [3.243.00 episodes/patient]. Microbiologically documented infection (MDI), clinically documented infection (CDI), and unknown fever (UF) accounted for 41.6%, 34.0% and 24.4%, respectively, of the total infections. Pneumonia (15.1%) was the most common infection. Among the 187 MDIs, bacterial infection, viral infection and fungal infection accounted for 50.3%, 39.6%, and 7.5%, respectively. Twelve of 24 deaths in the late post-transplantation period were related with infection. The statistically significant risk factors for infection related to mortality, by multivariate analysis, were the underlying disease risk, the duration of neutropenia, the failure of stem cell engraftment, acute GVHD, MDI, UF, the number of infectious episodes, bacteremia, fungemia, pneumonia, genitourinary tract infections, S. aureus, E. coli, Pseudomonas spp., Aspergillus spp., Non-albicans candida and CMV diseases.
CONCLUSIONS
The incidence of fungal infections was still low in our institute, even though prophylaxis for fungal infections was not applied, except for gargling with nystatin. In addition, most of them were non-albican Candida and Aspergillus species. Therefore, routine fluconazole prophylaxis may not be needed in our institute.