Clinical Risk Factors for Infection and Antibiotic Resistance in BMT Patients

Abstract

Bacterial infections continue to be a leading cause of mortality and morbidity in blood or bone marrow transplant (BMT) patients. The relative importance of different clinical features (donor type, graft cell source, and conditioning regimen) on the incidence and timing of post-transplant bacterial infections is uncertain, but a detailed analysis could better guide prevention and therapy. We retrospectively analyzed the incidence and risk factors for bacterial infection, as well as patterns of antibiotic resistance, in 834 BMT patients at the University of Minnesota from 2005-2010. We found that donor type has the greatest impact on the incidence of infection in BMT patients out to 100 days post-transplant. Full intensity, myeloablative conditioning, compared to reduced intensity conditioning is also associated with a greater risk of bacteremia, as is later development of acute GVHD. Additionally, BMT patients, compared to the contemporaneous hospital population, develop infections with resistance to many antibiotics used for both prophylaxis and treatment against commonly isolated bacterial organisms. These findings have important clinical implications regarding the use and selection of both prophylaxis and empiric antibiotic regimens.