Prevention of invasive fungal infections during bone marrow transplantation

1994 ◽  
Vol 69 (3) ◽  
pp. 157-157 ◽  
Author(s):  
R. Martino ◽  
A. Altés ◽  
A. Sureda ◽  
S. Brunet ◽  
A. Domingo-Albós
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Fungal Infections ◽  
Invasive Fungal Infections

Ten years' experience with liposomal amphotericin B in transplant recipients at Huddinge University Hospital

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 51-55 ◽  
Author(s):  
Olle Ringdén
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Amphotericin B ◽  
Marrow Transplantation ◽  
Fungal Infections ◽  
University Hospital ◽  
Fungal Colonization ◽  
Double Blind Study ◽  
Transplant Recipients ◽  
Double Blind

Abstract Our substantial experience in several trials with AmBisome in adult and paediatric patients undergoing transplantation has shown this formulation of amphotericin B to be safe and effective in therapeutic and prophylactic use. AmBisome has shown a significant reduction in fungal colonization and invasive Candida infections compared with placebo in a prospec-tive, double-blind study in bone marrow transplantation, and eradication of invasive fungal infections in 86% of 14 children undergoing bone marrow transplantation. The main side effects of AmBisome use are elevations in serum potassium and creatinine, but these lead to very few withdrawals from treatment. Compared with conventional amphotericin B, AmBisome is very expensive, but its much improved safety profile and proven efficacy make it an excellent agent for management of invasive fungal disease in transplant recipients.

Pulmonary Complications After Bone Marrow Transplantation: An Autopsy Study From a Large Transplantation Center

2005 ◽  
Vol 129 (3) ◽  
pp. 366-371 ◽  
Author(s):  
Monika Roychowdhury ◽  
Stefan E. Pambuccian ◽  
Deniz L. Aslan ◽  
Jose Jessurun ◽  
Alan G. Rose ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Fungal Infections ◽  
Diffuse Alveolar Damage ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Complications ◽  
Bleeding Tendency ◽  
Autopsy Study ◽  
Poor General Health

Abstract Context.—Bone marrow transplantation (BMT) is used to treat various malignant and nonmalignant disorders. Pulmonary complications are some of the most common causes of mortality in BMT recipients. Poor general health and bleeding tendency frequently preclude the use of definitive diagnostic tests, such as open lung biopsy, in these patients. Objective.—To identify pulmonary complications after BMT and their role as the cause of death (COD). Design.—The autopsy and bronchoalveolar lavage (BAL) slides and microbiology studies of BMT recipients from a 7-year period were reviewed. Results.—Pulmonary complications were identified in 40 (80%) of the 50 cases. The most common complications were diffuse alveolar damage (DAD) and diffuse alveolar hemorrhage (DAH). Pulmonary complications were the sole or 1 of multiple CODs in 37 cases (74%). All complications were more common in allogeneic BMT recipients. In 19 (51%) of the 37 cases in which pulmonary complications contributed to the death, cultures were negative. Both DAD and DAH, complications commonly reported in the early post-BMT period, were seen more than 100 days after BMT in 33% and 12% of cases, respectively. Five (83%) of 6 cases of invasive pulmonary aspergillosis diagnosed at autopsy were negative for fungi ante mortem (by BAL and cultures). Conclusions.—Pulmonary complications are a significant COD in BMT recipients, many of which, especially the fungal infections, are difficult to diagnose ante mortem. The etiology of DAD and DAH is likely to be multifactorial, and these complications are not limited to the early posttransplantation period. Autopsy examination is important in determining the COD in BMT recipients.

scholarly journals Selective decontamination in bone marrow transplant recipients

1992 ◽  
Vol 109 (3) ◽  
pp. 349-360 ◽  
Author(s):  
H. F. L. Guiot ◽  
R. Van Furth
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Marrow Transplantation ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Selective Decontamination ◽  
Serum Concentrations ◽  
Standard Regimen ◽  
Gram Negative ◽  
Cytotoxic Treatment

SUMMARYPatients undergoing bone marrow transplantation become immuno-compromised for various reasons. Deep granulocytopenia, induced by conditioning (chemotherapy and total body irradiation), renders the patient at risk for serious bacterial and fungal infections. Our strategy for prevention of these infections by selective decontamination (SD) is the result of more than 15 years of clinical experience and research. The combination of antibiotics, used as standard SD (neomycin, polymyxin B, pipemidic acid and amphotericin B), with the application of local antimicrobial agents eliminates aerobic Gram-negative rods, Staphylococcus aureus and Candida spp. from the mucosal surfaces of the digestive tract, while the majority of the anaerobic flora persist and support colonization resistance (CR). The antibiotics used either are not resorbed or do not yield therapeutic serum concentrations. Antibiotics which induce therapeutic serum concentrations, such as ciprofloxacin and cotrimoxazole, are only used for SD on a limited scale. When Gram-negative rods persist despite intake of the standard regimen, ciprofloxacin is given until these persisting rods are eliminated. If the patients cannot swallow the oral regimen, i.v. cotrimoxazole is given temporarily. Streptococcal infections are prevented by the i.v. adminstration of penicillin for 14 days starting on the first day after cytotoxic treatment (conditioning for bone marrow transplantation). The combination of SD and systemic prophylaxis has been shown to be adequate; the major problem then remaining is a relatively mild catheter-associated infection with coagulase-negative staphylococci.

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