tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 3)

Bacterial Infections In the first month after hematopoietic stem cell transplantation, infectious complications are similar to those in granulocytopenic patients receiving chemotherapy for acute leukemia (Chap. 82). Because of the anticipated 1- to 3week duration of neutropenia and the high rate of bacterial infection in this population, many centers give prophylactic antibiotics to patients upon initiation of myeloablative therapy. Quinolones decrease the incidence of gram-negative bacteremia among these patients. Bacterial infections are common in the first few days after hematopoietic stem cell transplantation. . | Chapter 126. Infections in Transplant Recipients Part 3 Bacterial Infections In the first month after hematopoietic stem cell transplantation infectious complications are similar to those in granulocytopenic patients receiving chemotherapy for acute leukemia Chap. 82 . Because of the anticipated 1- to 3week duration of neutropenia and the high rate of bacterial infection in this population many centers give prophylactic antibiotics to patients upon initiation of myeloablative therapy. Quinolones decrease the incidence of gram-negative bacteremia among these patients. Bacterial infections are common in the first few days after hematopoietic stem cell transplantation. The organisms involved are predominantly those found on the skin or in IV catheters Staphylococcus aureus coagulase-negative staphylococci and aerobic bacteria that colonize the bowel Escherichia coli Klebsiella Pseudomonas . Beyond the first few days of neutropenia infections with filamentous bacteria such as Nocardia become more common. Episodes of bacteremia due to encapsulated organisms mark the late posttransplantation period 6 months after hematopoietic stem cell reconstitution . Chemotherapy and use of broad-spectrum antibiotics place HSCT patients at risk for diarrhea and colitis caused by Clostridium difficile overgrowth and toxin production. Fungal Infections Beyond the first week after transplantation fungal infections become increasingly common particularly among patients who have received broadspectrum antibiotics. As in most granulocytopenic patients Candida infections are most commonly seen in this setting. With increased use of prophylactic fluconazole infections with resistant fungi in particular Aspergillus and other molds Fusarium Scedosporium Penicillium have become more common prompting some centers to replace fluconazole with agents such as caspofungin voriconazole and posaconazole. The role of antifungal prophylaxis with these different agents in contrast to empirical treatment .