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Comparison of two different anti-infectious approaches after high-dose chemotherapy and autologous stem cell transplantation for hematologic malignancies in a 12-year period in British Hospital, Uruguay.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-02-15 , DOI: 10.1007/s00277-020-03947-1
Ana Carolina Oliver 1 , Eloisa Riva 1 , Ricardo Mosquera 1 , Sebastian Galeano 1 , Silvia Pierri 1 , Laura Bello 1 , Ada Caneiro 1 , Regis Gai 1 , Andrew Miller 1 , Pablo Muxi 1
Affiliation  

Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006-2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013-2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.

中文翻译:

在乌拉圭英国医院进行的为期12年的大剂量化疗和自体干细胞移植治疗血液系统恶性肿瘤后的两种不同抗感染方法的比较。

自体干细胞移植(ASCT)是一种广泛用于治疗大多数血液系统疾病的安全方法。这些患者有感染并发症的风险,这是发病的主要原因,也是死亡的第二原因。这项对我们机构中266名连续未选ASCT患者的感染发生率,类型和严重性的12年回顾性分析提供了解决该问题的新颖信息。我们纳入了266条ASCT程序。2006-2013年期间的患者被称为第1组(环丙沙星预防和头孢他啶-阿米卡星为经验性抗生素),而2013-2017年期间的患者被称为第2组(左氧氟沙星预防和美罗培南为经验性抗生素)。第一组发热性中性粒细胞减少症的发生率为72%,第二组发热性中性粒细胞减少症的发生率为86.2%(p = 0.004)。大部分传染性发作与不明原因的发烧有关:第1组为55%,第2组为59%。第1组的发热不明原因发烧率为82.6%,第2组为80%。年龄,低血球蛋白血症和ASCT晚期疾病。两组之间在阳性血液培养中没有发现关于最常见药物的差异(Gram +在第1组中为66.6%,在第2组中为69%(p = 0.68))。移植后100天内死亡率较低,为1.87%。不管使用哪种预防方案,大多数患者在ASCT背景下都会出现高热发作,来历不明的发烧是最常见的感染并发症,而Gram +剂在两组中均很普遍。死亡率低。根据我们的结果,ASCT是一种安全的程序,左氧氟沙星与环丙沙星的预防没有明显的益处。两种抗感染方法都是可以接受的,产生相似的结果。
更新日期:2020-02-18
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