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동종골수이식 후의 초기 감염양상 : 감시배양의 유용성

Other Titles
 Early Infectious Complications in Allogeneic Bone Marrow Transplantation : Role of Surveillance Culture 
Authors
 이승태  ;  한지숙  ;  정소영  ;  김성철  ;  민유홍  ;  고윤웅 
Citation
 대한조혈모세포이식학회지, Vol.3(2) : 209-220, 1998 
Journal Title
 대한조혈모세포이식학회지 
ISSN
 1598-6039 
Issue Date
1998
Abstract
Background : Infectious complications are responsible for the majority of early treatment-associated mortality after allogeneic bone marrow transplantation, and in early recovery phase, proper prophylaxis and treatment of infection are recognized as a pivotal point for better results of allogeneic bone marrow transplantation. The causative agents of infection in the early recovery phase are bacteria and fungus, most of which can be isolated from the patient's own flora. Serial surveillance culture performed in order to identify a specific pathogen during the colonization phase may provide a guidance for earlier use of appropriate antimicrobial therapy at the first sign of infection. The author reported here, the clinical characteristics, risk factors of the early infectious complications in allogeneic bone marrow transplantation and clinical significance of surveillance culture. Methods : We reviewed the medical records of the 45 consecutive patients received allogeneic bone marrow transplantation from November 1991 to December 1997 at Severance hospital and analyzed clinical features of infectious complications during the first 30 days after marrow transplantation. Results: 1) Time and duration of infectious fever: Febrile episodes associated with infection were developed in 15 cases (33.3%) of a total 45 cases, 9 cases (20%) were MDI, 6 cases (13.3%) were CDI. All the episodes were developed before engraftment, and the median day of the first fever was day 10 (2-23) posttransplant, median duration was 7 days (2-24 days). 2) Sites of infection and causative organisms: The most common site of infection was oropharynx (7 cases (46.7%), MDI 4 cases, CDI 3 cases), followed by lung (3 cases (20.0%), MDI 12cases, CDI 1 cases), anus (MDI 2 cases (13.3%)), skin (CDI 2 cases (13.3%)), GI tract (MDI 1 case (6.7%)). Among 9 cases of MDI, gram negative bacilli is the most common causative organism (5 cases, 55.5%), followed by fungus 3 cases (33.3%), and gram positive cocci 1 case (11.1%). Among 6 cases of CDI, 5 cases were suspected of gram positive infection(mucositis in 3 cases, skin furuncle in 2 cases), and 1 case pulmonary aspergillosis. 3) Risk factors of infection : Incidences of high risk status of underlying disease and decontamination failure were significantly higher in cases with infection compared to cases with no infection (60% vs 30%, p=0.04; 46.6% vs 3.3%, p<0.01) and duration of neutrophil count below 1,000/μL was also more prolonged (19.8 days vs 15 days, p<0.01). 4) Correlation between decontamination failure and infection: Decontamination failure was abserved in 8 cases (17.8%) of the total 45 cases, and 7 (46.6%) of 15 cases with infection. The primary sites of infection in these 7 cases were revealed as the same sites where the organisms detected by surveillance culture. Conclusion : The risk factors of infection in the early posttransplant period were revealed as high risk status of underlying disease, prolonged duration of neutropenia, and decontamination failure, and the last finding may suggest possible infection predictability of surveillance culture results.
Files in This Item:
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/176988
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