Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation

A. Chizuka, M. Kami, Y. Kanda, N. Murashige, Y. Kishi, T. Hamaki, S. W. Kim, A. Hori, R. Kojima, S. I. Mori, R. Tanosaki, H. Gomi, Y. Takaue

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Abstract

Bloodstream infection (BSI) is a significant complication following allogeneic hematopoietic stem cell transplantation (allo-SCT). Corticosteroids mask inflammatory responses, delaying the initiation of antibiotics. We reviewed medical records of 69 allo-SCT patients who had been on >0.5mg/kg prednisolone to investigate the efficacy of weekly surveillance blood cultures. A total of 36 patients (52%) had positive cultures, 25 definitive BSI and 11 probable BSI. Pathogens in definitive BSI were Staphylococcus epidermidis (n = 7), S. aureus (n = 4), Entrococcus faecalis (n = 3), Pseudomonas aeruginosa (n = 5), Acenitobacter Iwoffii (n = 4), and others (n = 10). The median interval from the initiation of corticosteroids to the first positive cultures was 24 days (range, 1-70). At the first positive cultures, 15 patients with definitive BSI were afebrile. Four of them remained afebrile throughout the period of positive surveillance cultures. Patients with afebrile BSI tended to be older (P = 0.063), and had in-dwelling central venous catheters less frequently than febrile patients (P < 0.0001). Bloodstream pathogens were directly responsible for death in two patients with afebrile BSI. This study demonstrates that cortisosteroid frequently masks inflammatory reactions in allo-SCT recipients given conrticosteroids, and that surveillance blood culture is only diagnostic clue for 'occult' BSI.

Original languageEnglish
Pages (from-to)577-582
Number of pages6
JournalBone Marrow Transplantation
Volume35
Issue number6
DOIs
Publication statusPublished - 2005 Mar 1

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Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Bloodstream infection
  • Graft-versus-host disease

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Chizuka, A., Kami, M., Kanda, Y., Murashige, N., Kishi, Y., Hamaki, T., Kim, S. W., Hori, A., Kojima, R., Mori, S. I., Tanosaki, R., Gomi, H., & Takaue, Y. (2005). Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplantation, 35(6), 577-582. https://doi.org/10.1038/sj.bmt.1704830