The Clinical Analysis Of Infection Complication After Hematopoietic Stem Cells Transplantation

Objective To study the clinical characteristics of infection complication in different periods after hematopoietic stem cells transplantation (HSCT), providing theory basis for conducting, prophylactic antibiotic and treatment of infection complications after HSCT.Methods We sought to retrospectively analyze the incidence, pathogenic and related risk factors of infection in 381 cases who underwent hematopoietic stem cells transplantation in the first affiliated hospital of soochow university.Results l.The cumulative incidence of infection post-transplant was 84.2%, the median time of infection was 22 days(range 0-180 days). The incidence of infecti on within 30 days was 61.2% and the incidence of infection between 30 days to 1 00 days and 100ays to 180 days were 65.5%,26.2%, respectively.2.There were 168 strains bacteria cultured post-transplant and 50.0% within 30 days. Between 0-1 80 days, there were 83 strains bacteria cultured byblood or catheter and 81.9% wit hin 30 days,60 of 83(72.3%) bacteria pathogenic were gram-negative bacilli and gr am-positive bacilli 27.7%. Most of the bacteremia pathogenic were MDR(61.4%) an d most of MDR were gram-positive bacilli(76.5%). The percentage of multiple drug resistant bacterial (MDR) was 59.5% within 30 days post-transplant; the percentag e of MDR in the 30 days to 100 days time period was 77.1% and in the 100 day s to 180 days time period was 78.5%.3.Virus infection post-transplant occured mainl y in 30-100 days, the cumulative incidence of Cytomegalovirus (CMV) infection p ost-transplant was 26.5% and the cumulative incidence of Epstein-barr virus (EBV) infection was 20.5%.82 cases were tested positive for EBV-DNA.118 cases were te sted for CMV-DNA(PCR) and CMV-pp65 in peripheral blood post-transplant.4.Thei ncidence of invasivefungal infection(IFI) within 30 days,30 days to 100 days,10 0 days to 180 days were 5.2%(20/381),7.9%(26/331),3.0%(9/303), respectiv ely.1 case(0.1%) was diagnosied as definite invasive fungal infection (IFI),32 of 1015 (3.2%) were diagnosied as probable IFI and 22 of 1015(2.2%) were possible IFI post-transplant.5.The risk factors that evaluated includedpatient’s age, sex, disea se type, conditioning regimen, Human leukocyte antigen (HLA) match, donor type, graft-versus-host disease(GVHD) and Antithymocyte globulin(ATG)/Antilymphocyte g lobulin(ALG) applications. The independent risk factors for infection evaluated by multivariable Logistic regression were ATG/ALG application and acute graft-versus-h ost disease(GVHD) of Ⅱ-Ⅳ degreesoccurrence in the early period (0-30 days) post-transplant; Acute GVHD of Ⅱ-Ⅳ degrees, ATG/ALG applications and HLA-unmat ched were independent risk factors in infectious complications in the 30-100 days ti me period; In the 100-180 days time period,the independent risk factors for infectio n was chronic GVHD.Conclusions Bacterial infection is the main infection post-transplant, commonly accompanied by viruses and fungi.Pathogenic bacterial was mainly gram-negative ba cteria and MDR.Virus infection post-transplant occured mainly in 30-100 days and f ungal infection in all 3 time periods post-transplant. ATG/ALG applications, occuren ce of GVHD and HLA-unmatched were significantly associated with the incidenc e of infection after hematopoietic stem cell transplantation.