Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

The effect of an extensive prophylactic antimicrobial regimen was prospecti vely assessed in 126 patients after high-dose chemotherapy and autologous P BSC, They received ciprofloxacin (500 mg/12 h), acyclovir (200 mg/6 h), and itraconazole (200 mg/12 h) orally until neutrophil recovery, Febrile patie nts received i.v. imipenem (500 mg/6 h) to which vancomycin and amikacin we re added if fever persisted for 2-3 and 5 days, respectively, Amphotericin B lipid complex was further given on day 7 or 8 of fever. Median times for a neutrophil count of >0.5 x 10(9)/l and a platelet count of >20 x 10(9)/l were 9 and 11 days. Severe neutropenia (<0.1 x 10(9)/l) lasted for a median of 5 days in which 72% of febrile episodes and 50% of cases of bacteremia occurred, Grampositive bacteria were isolated in 30 of 40 episodes of bacte remia, 25 of which were caused by Staphylococcus epidermidis, Clinical foci were the intravascular catheter in 35 cases, respiratory infection in 11, cellulitis in two, anal abscess in one, and neutropenic enterocolitis in on e, The high incidence of febrile episodes (94%) and bacteremias (31%) may b e due to the lack of efficacy of antimicrobial prophylaxis and the persiste nce of a 5-day period of severe neutropenia.