Bloodstream infections can develop late (after day 100) and/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation

We retrospectively evaluated the incidence and time from transplantation of bloodstream infections occurring in children receiving bone marrow transpl ant (BMT) at G Gaslini Children's Hospital between September 1984 and Decem ber 1997, During this period the incidence was 35% after allogeneic and 26% after autologous BMT (P=0.08). Among these episodes, 38% after allogeneic BMT and 90% after autologous BMT were detected in the presence of neutropen ia within the first 30 days from reinfusion (P < 0.001). Incidence of cathe ter-related bloodstream infections was 40% after allogeneic and 8% after au tologous BMT (P < 0.001). Bloodstream infections in the absence of neutrope nia were 55% after allogeneic BMT vs 10% after autologous BMT (P < 0.001) a nd occurred later after reinfusion (mean 199 vs 41 days, P <0.001). Among t he episodes occurring after allogeneic BMT and in the absence of neutropeni a, 61% were related to the presence of a central venous catheter, 15% were related to the presence of GVHD, but 23% were not associated with any of ma jor risk factors for infection. Finally, 38% of episodes following allogene ic BMT were detected after day 100 vs 1% after autologous BMT, We concluded that patients receiving allogeneic BMT experience a high incidence of bloo dstream infections in the absence of neutropenia and that a significant pro portion of these episodes is not clearly associated with well known risk fa ctors such as GVHD or central venous catheters, Moreover, many episodes dev elop a long time after the transplantation procedure. Therefore, any febril e episode following allogeneic BMT even late and/or in the absence of neutr openia should be intensively managed.