Management of bacteremia in patients undergoing hematopoietic stem cell transplantation

Research output: Contribution to journalArticle

Abstract

Bacteremias represent severe infectious complications following hematopoietic stem cell transplantation (HSCT). Frequency is highest during the pre-engraftment period, both in autologous and in allogeneic HSCT, when patients are granulocytopenic. In the postengraftment period, bacteremias are also frequent in the absence of neutropenia, especially after allogeneic HSCT. Antibacterial prophylaxis with fluoroquinolones during pre-engraftment neutropenia could be justified both in autologous and allogeneic HSCT, but the possibility of infections caused by resistant pathogens should be carefully evaluated. Empirical antibacterial therapy must be chosen on the basis of local epidemiology and should be administered in all febrile HSCT recipients, regardless of the presence of neutropenia. This approach appears to be justified by the high incidence of bacteremia in any post-transplant period and by the high mortality rate that is observed if appropriate treatment is delayed, especially in infections caused by specific pathogens (e.g., Gram-negative rods).

Original languageEnglish
Pages (from-to)607-621
Number of pages15
JournalExpert Review of Anti-Infective Therapy
Volume7
Issue number5
DOIs
Publication statusPublished - Jun 2009

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Hematopoietic Stem Cell Transplantation
Bacteremia
Neutropenia
Fluoroquinolones
Infection
Epidemiology
Fever
Transplants
Mortality
Incidence
Therapeutics

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Antibacterial prophylaxis
  • Autologous hemopoietic stem cell transplantation
  • Bacteremia
  • Empirical antibacterial therapy

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)
  • Microbiology
  • Virology

Cite this

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abstract = "Bacteremias represent severe infectious complications following hematopoietic stem cell transplantation (HSCT). Frequency is highest during the pre-engraftment period, both in autologous and in allogeneic HSCT, when patients are granulocytopenic. In the postengraftment period, bacteremias are also frequent in the absence of neutropenia, especially after allogeneic HSCT. Antibacterial prophylaxis with fluoroquinolones during pre-engraftment neutropenia could be justified both in autologous and allogeneic HSCT, but the possibility of infections caused by resistant pathogens should be carefully evaluated. Empirical antibacterial therapy must be chosen on the basis of local epidemiology and should be administered in all febrile HSCT recipients, regardless of the presence of neutropenia. This approach appears to be justified by the high incidence of bacteremia in any post-transplant period and by the high mortality rate that is observed if appropriate treatment is delayed, especially in infections caused by specific pathogens (e.g., Gram-negative rods).",
keywords = "Allogeneic hematopoietic stem cell transplantation, Antibacterial prophylaxis, Autologous hemopoietic stem cell transplantation, Bacteremia, Empirical antibacterial therapy",
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