Epidemiological control at the bone marrow transplantation department

Summary

Introduction

Bone marrow transplantation (BMT) is among main approaches to treatment of systemic blood disorders as well as for some inherited and inborn diseases. The transplantation is preceded by a conditioning regimen which results into cytopenia and high risk of bleeding and infectious complications. Materials and methods To assess incidence and severity of infectious complications, we performed an appropriate study at the pediatric BMT Department No.1 of the R.Gorbacheva Memorial Institute. To this purpose, we selected 37 patients who underwent BMT. The group included 26 boys (70.2%), and 11 girls (29.8%), at a median age of 6.5 (1 to 12) years. Twenty-eight patients (75.7%) had primary malignant hematological diseases, i.e., ALL, AML, MDS, JMML; other 9 patients (24.3%) suffered from nonmalignant diseases: aplastic anemia, mucopolysaccharidosis type I (Hurler syndrome); adrenoleukodystrophy, Schwachmann-Diamond syndrome; β-talassaemia, and Wiscott-Aldrich syndrome. Ninety patients (51.3%) were subject to allogeneic matched unrelated BMT; five patients (13.3%) received allogeneic related BMT, and other 13 patients were subject to haploidentical BMT. Of them, 15 children were beyond remission (40.5%), and 14 patients (37.8%), in remission state. The remission state at BMT was not determined in 8 patients with inherited and inborn disorders. 25 patients (67.5%) have received a myeloablative conditioning regimen, whereas 12 children (32.4%) were exposed to reduced-intensity conditioning.

Results

Positive bacterial cultures were revealed in all the patients; in 25 cases (67.6%), the microbial inoculation was found before their admittance to the BMT department. Most microorganisms were revealed in oropharyx, being found in 36 patients (97.3%). In 31 patient, urinary positive cultures were obtained (83.8%); in 18 patients (48.6%), intestinal pathogens were isolated; 12 patients (32.4%) had positive hemocultures (the catheter-associated blood infections were found in nine of them). Microbial contamination was less common in bronchoalveolar lavage samples (five patients with positive cultures), and, in two patients, the bacterial cultures were positive in materials from wounds, fistulas, and pustules (5,5%). All the patients showed inoculation with anaerobic microflora. Moreover, aerobic bacteria were cultured in five patients.

Conclusion

Infectious complications, including those caused by opportunistic flora, are common in early post-transplant period, in the patients after allogeneic hematopoietic stem cell transplantation. Infectious conditions take a high positions among causes of death after BMT. Strict observation of sanitary and epidemiological instructions, aseptic and antiseptic rules are required at the departments for cytopenic patients. Personal hygiene control is necessary in the patient, as well as instruction of the relatives in the rules and features of care in the patients who has received allogeneic BMT. Choice of antiseptics should be based, taking into account local epidemiological situation and microbial sensitivity.

Keywords

Bone marrow transplantation, microbial cultures, frequency, epidemiology.