Abstract
BackgroundSurveillance blood cultures are often obtained in hematopoietic stem cell transplant (HSCT) patients for detection of bloodstream infection. The major aims of this retrospective cohort study were to determine the utility of the practice of obtaining surveillance blood cultures from asymptomatic patients during the first 100 post-transplant days and to determine if obtaining more than one positive blood culture helps in the diagnosis of bloodstream infection.MethodsWe conducted a 17-month retrospective analysis of all blood cultures obtained for patients admitted to the hospital for HSCT from January 2010 to June 2011. Each patient’s clinical course, vital signs, diagnostic testing, treatment, and response to treatment were reviewed. The association between number of positive blood cultures and the final diagnosis was analyzed.ResultsBlood culture results for 205 patients were reviewed. Cultures obtained when symptoms of infection were present (clinical cultures) accounted for 1,033 culture sets, whereas 2,474 culture sets were classified as surveillance cultures (no symptoms of infection were present). The total number of positive blood cultures was 185 sets (5.3% of cultures obtained) and accounted for 84 positive culture episodes. Incidence of infection in autologous, related allogeneic and unrelated allogeneic transplants was 8.3%, 20.0%, and 28.6% respectively. Coagulase-negative staphylococci were the most common organisms isolated. Based on our application of predefined criteria there were 29 infections and 55 episodes of positive blood cultures that were not infections. None of the patients who developed infection were diagnosed by surveillance blood cultures. None of the uninfected patients with positive blood cultures showed any clinical changes after receiving antibiotics. There was a significant difference between the incidence of BSI in the first and second 50-day periods post-HSCT. There was no association between the number of positive blood cultures and the final diagnosis.ConclusionSurveillance blood cultures in patients who have undergone HSCT do not identify bloodstream infections. The number of positive blood cultures was not helpful in determining which patients had infection. Patients are at higher risk of infection in the first 50 days post-transplant period.
Highlights
Bloodstream infection (BSI) remains a significant complication following hematopoietic stem cell transplantation (HSCT), with post-transplant BSI occurring in 12.5 to 41% of patients [1,2,3,4,5,6,7,8]
The primary objective of this study was to investigate whether surveillance blood cultures are valuable in the early diagnosis of BSI during the first 100 days post-transplant
Total with predefined diagnostic criteria, we found that surveillance blood cultures did not detect a single case of BSI
Summary
Bloodstream infection (BSI) remains a significant complication following hematopoietic stem cell transplantation (HSCT), with post-transplant BSI occurring in 12.5 to 41% of patients [1,2,3,4,5,6,7,8]. Antimicrobial prophylaxis and corticosteroid therapy may make it more difficult to transplant or the patients’ age [13,14,15,16,17]. These studies have come to differing conclusions [10,11,12,13]. The primary objective of this study was to investigate whether surveillance blood cultures (performed weekly per our hospital protocol) are valuable in the early diagnosis of BSI during the first 100 days post-transplant. Surveillance blood cultures are often obtained in hematopoietic stem cell transplant (HSCT) patients for detection of bloodstream infection. The major aims of this retrospective cohort study were to determine the utility of the practice of obtaining surveillance blood cultures from asymptomatic patients during the first 100 posttransplant days and to determine if obtaining more than one positive blood culture helps in the diagnosis of bloodstream infection
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