Early infections complications after bone marrow transplantation requiringmedical ICU admission

The objective of this study was to define the type, the incidence and the o utcome of early infectious complications (mean interval between day 1 post- BMT and the onset of fever was 9 +/- 3 days) occurring in granulocytopenic bone marrow transplant recipients, requiring medical intensive care unit ad mission. Over a five-years period, forty-one patients with microbiologicall y confirmed infection were enrolled, with a statistically significant highe r frequency of allogeneic marrow transplant recipients (51%, p < 0.02). Inf ectious pneumonia occurred in 24 patients (59%), septicemia with septic sho ck in ten patients (24%), catheter-related infection in 5 patients (12%) an d meningitis in 2 patients (5%) (p < 0.001). Twenty-six patients died (63%) . Among the patients with confirmed infectious pneumonitis, which occurred most frequently in allogeneic marrow recipients (p < 0.02), 16 died (67%). This poor outcome was related to the requirement of mechanical ventilation. Eight patients (80%) with septicemia and septic shock and the two patients with meningitis died. Bacteria (Pseudomonas aeruginosa and Staphylococcal species) were the most common isolated in bronchoalveolar lavage fluid and blood cultures. We found a lower incidence of fungal or viral infections co mpared to previous studies. Empiric antimicrobial therapy in the cases of p atients admitted in ICU may be included antibiotics anti-Pseudomonas and an ti-Staphyloccocus as the ecology of hematology unit. The requirement of mec hanical ventilation is the main adverse prognostic factor in transplanted p atients. At ICU admission, patients with hepatic failure combined with resp iratory failure represented a subgroup with a dismal prognosis.