Infections in Hematopoietic Stem Cell Transplantation Recipients in the Pre-Engraftment Period

Introduction: The recipients of the hematopoietic stem cell transplantation (HSCT) are at increased risk of a variety of infections due to their immunocompromised state. The severity of the immunocompromise differs depending upon host, underlying disease, comorbidities, type of transplantation, conditioning regimen, and immunosuppressive drugs. Pre-engraftment period is attended by neutropenia, mucosal barrier disruption, broad spectrum antibiotic usage and invasive procedures like central lines. Aim: We sought to evaluate the type and frequency of the infections in the pre-engraftment period in our transplant center. Methods and Results: We reviewed 17 HSCT cases done in our center over 24 months from August, 2011 upto August, 2013 which included 11 autologous and 6 allogeneic HSCT cases. We found a total of 20 febrile neutropenic episodes with 12 bacterial and 6 fungal infections. Eighteen of the 73 cultures were positive (24.65%). Nine out of 17 patients (52.94%) had at least one culture positive. Eight out of 11 bacteria were ESBL producing (extended spectrum beta lactamase) and one organism was only sensitive to colistin. Only 2 of the 12 bacteria were gram positive (16.67%). Only one stool test was positive for Clostridium deficile. We had only one culture documented fungal infection (Aspergillus sinusitis) and 5 presumed Aspergillus infections. Conclusion: The incidence of febrile neutropenia is similar to other centers in India and Western world, though the organisms are different. Gram negative bacteria continue to be the major threat to hematopoietic cell transplant recipients especially in the early post-transplant period in India