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

研究成果: Article査読

26 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)577-582
ページ数6
ジャーナルBone Marrow Transplantation
35
6
DOI
出版ステータスPublished - 2005 3
外部発表はい

ASJC Scopus subject areas

  • 血液学
  • 移植

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