Infections in Bone Marrow Recipients (1985~1996)

Kim, Hong Bin; Park, Sang Won; Kim, Ui Seok; Kim, Nam Joong; Shin, Dong Hyeon; Oh, Myoungdon; Park, Seon Yang; Kim, Byung Kook; Choe, Kang Won

Abstract

BACKGROUND: Infection and graft-versus-host disease (GVHD) are major causes of morbidity and mortality following bone marrow transplantation (BMT). The objective of this study was to define the incidence, type, and timing of infectious complications in bone marrow recipients.
METHODS
Ninety-four patients, including 71 allogeneic and 23 autologous cases, underwent BMT at the Seoul National University Hospital. Their medical records were reviewed retrospectively.
RESULTS
Medical records of 74 subjects (53 allogeneic, 21 autologous) were available. In allogeneic recipeints the majority of patients had a diagnosis of leukemia (47.9%) and in autologous ones lymphoma (66.7%). Median duration of follow-up was 11 (0~82) months and 3 (1~45) months in each group. Out of 40 allogeneic and 17 autologous recipients, 95 and 27 febrile episodes occurred, respectively. During pre-engraftment, post-engraftment (to day 100), and post-transplantation period (100 days or later), 57, 45, and 19 episodes developed, respectively. Clinically-defined infection, microbiologically-defined infection, and un-known fever accounted for 52.5% (64/112), 33.6% (41/112) and 13.9% (17/112), respectively. Infection of the oral cavity occurred in 27.6% (28/105), skin infection in 21.9% (23/105), and pneumonia in 14.3% (15/105). Fourteen (58.3%) of 24 bacterial infections were caused by gram-negative bacilli and 10 (41.7%) by gram-positive cocci, most often coagulase-negative staphylococci. Fungi, including Pneumocystis carinii, and viruses were involved in 16.0% (7/44) and 29.5% (13/44), respectively. Ten of 122 cases (8.2%) expired despite treatment; eight patients died due to infectious complications, including 7 with pneumonia and 1 with primary bacteremia, and 2 dies due to non-infectious complications.
CONCLUSION
Infections are the most frequent serious complications of bone marrow transplantation. The majority occurred by day 100 after BMT and oral mucositis was the most common type of infection.