Journal Article

Early Infection in Bone Marrow Transplantation: Quantitative Study of Clinical Factors That Affect Risk

Eric A. Engels, Charles A. Ellis, Stacey E. Supran, Christopher H. Schmid, Michael Barza, David P. Schenkein, Yener Koc, Kenneth B. Miller and John B. Wong

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 2, pages 256-266
Published in print February 1999 | ISSN: 1058-4838
Published online February 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/515103
Early Infection in Bone Marrow Transplantation: Quantitative Study of Clinical Factors That Affect Risk

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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 ⩽ .05). In a survival regression model, variables independently associated with infection risk were the log10 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.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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