Abstract
Blood stream infections (BSIs) are a serious problem in patients with hematologic malignancies receiving allogeneic hematopoietic stem cell transplantation (ASCT). We evaluated the clinical utility of molecular diagnosis for the management of BSIs in such patients. We prospectively performed a polymerase chain reaction (PCR) analysis of microbial DNA in blood samples from 10 consecutive patients with hematological malignancies at least once a week for one month after ASCT. In total, 51 and 54 samples were analyzed by bacterial and fungal PCR assays, respectively. Bacteria were detected in 24 samples from 8 patients by PCR, but in only 2 samples from one patient by blood culture. Notably, the bacteria detected in at least half of the 24 samples were considered to have originated from the oral cavity. Fungi were detected in 5 samples from 3 patients by PCR, but not by blood culture. Most cases with positive PCR results were manageable with empirical antimicrobial therapy without disclosure of DNA data. Our DNA analyses did not directly contribute to management of BSIs, but did provide valuable microbiological evidence for the patients. Additionally, oral management appears to require a critical re-evaluation to reduce the occurrence of BSIs in ASCT recipients.
Highlights
Allogeneic hematopoietic stem cell transplantation (ASCT) offers the chance of cure for patients with hematologic malignancies
We prospectively applied an original polymerase chain reaction (PCR) assay to find causative organisms in peripheral blood (PB) samples of patients with hematologic malignancies who had received allogeneic hematopoietic stem cell transplantation (ASCT), and we evaluated its clinical usefulness for managing Blood stream infections (BSIs)
Fifty-one PB samples from 10 patients were analyzed by bacterial PCR assays during the first month after ASCT (Figure 1)
Summary
Allogeneic hematopoietic stem cell transplantation (ASCT) offers the chance of cure for patients with hematologic malignancies. Blood stream infections (BSIs) are major causes of morbidity and mortality for patients undergoing ASCT [1]. Successful management of these infectious complications is essential to further improve the clinical outcome of such patients. BSIs commonly develop early after ASCT despite the use of prophylactic anti-infective drugs [1] [2]. There is no solution for BSI management other than empirical antimicrobial therapy despite the lack of microbiological evidence in a majority of ASCT recipients. PCR assays are reportedly useful in managing febrile neutropenia in patients with hematologic disorders [5] [6]. These molecular techniques have not been well evaluated in hematologic patients undergoing ASCT
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