Infections in adults undergoing unrelated donor bone marrow transplantation

This study retrospectively reviews infections over a 7-year period in 60 co nsecutive adults (median age 25 years) undergoing their first unrelated don or bone marrow transplant (UD-BMT). T-cell depletion was employed in 93%. M ore than half the patients had one or more severe, potentially life-threate ning, infections, There was a high incidence of invasive fungal infections (Aspergillus 17. Crandida four), despite the use of itraconazole or amphote ricin prophylaxis. Ten Aspergillus infections occurred beyond 100 d. Two pa tients (11%) with invasive aspergillosis survived. Clustering of infections was noted, with invasive fungal infections significantly associated with b acteraemias (OR 3.73, P=0.06) and multiple viral infections (OR 4.25, P=0.0 5). There were 21 severe viral infections in 16 patients, with CMV disease occurring in four patients only; viral pneumonitis was predominantly due to 'community respiratory' viruses, Most early bacteraemias (68%) were due to Gram-positive organisms, The majority of episodes uf Gram-negative sepsis were caused by non-fastidious nonfermentative bacteria, such as Pseudomonas spp. and Acinetobacterspp.. historically regarded as organisms of low path ogenicity, In patients with successful engraftment and minimal graft-versus -host disease, late infections suggestive of continued immune dysfunction ( shingles, recurrent lower respiratory infections, Salmonella enteritis and extensive warts) were common.