Early infection in bone marrow transplantation: Quantitative study of clinical factors that affect risk

被引:78
作者
Engels, EA
Ellis, CA
Supran, SE
Schmid, CH
Barza, M
Schenkein, DP
Koc, Y
Miller, KB
Wong, JB
机构
[1] Tufts Univ, Sch Med, New England Med Ctr, Div Clin Care Res, Boston, MA 02111 USA
[2] Tufts Univ, Sch Med, New England Med Ctr, Div Clin Decis Making, Boston, MA 02111 USA
[3] Tufts Univ, Sch Med, New England Med Ctr, Div Hematol Oncol, Boston, MA 02111 USA
[4] Tufts Univ, Sch Med, New England Med Ctr, Dept Med,Div Geog Med & Infect Dis, Boston, MA 02111 USA
[5] Tufts Univ, Sch Med, New England Med Ctr, Tupper Inst, Boston, MA 02111 USA
关键词
D O I
10.1086/515103
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Infections remain common life-threatening complications of bone marrow transplantation. To examine clinical factors that affect infection risk, we retrospectively studied patients who received bone marrow transplants (53 autologous and 51 allogeneic). Over a median of 27 hospital days, 44 patients developed documented infections. Both autologous transplantation and hematopoietic growth factor use were associated with less prolonged neutropenia and decreased occurrence of infection (P less than or equal to .05). In a survival regression model, variables independently associated with infection risk were the log(10) of the neutrophil count (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.32-0.75), ciprofloxacin prophylaxis (HR, 0.42; 95% CI, 0.19-0.95), empirical intravenous antibiotic use (HR, 0.09; 95% CI, 0.03-0.32), and an interaction between neutrophil count and intravenous antibiotic use (HR, 1.86; 95% CI, 1.06-3.29). In this model, infection risk increases steeply at low neutrophil counts for patients receiving no antibiotic therapy. Ciprofloxacin prophylaxis and particularly intravenous antibiotic therapy provide substantial protection at low neutrophil counts. These results can be used to model management strategies for transplant recipients.
引用
收藏
页码:256 / 266
页数:11
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