PMID- 17920999 OWN - NLM STAT- MEDLINE DCOM- 20080922 LR - 20080222 IS - 1201-9712 (Print) IS - 1201-9712 (Linking) VI - 12 IP - 2 DP - 2008 Mar TI - Post-transplant infections: single center experience from the developing world. PG - 203-14 AB - OBJECTIVE: To describe our experience of post-transplant infections in allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. METHODS: From July 2001 to September 2006, patients with malignant and non-malignant hematological disorders having human leukocyte antigen (HLA)-matched sibling donors were selected for transplant. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. After admission to the hospital, patients were kept in protective isolation rooms, equipped with a HEPA filter positive-pressure laminar airflow ventilation system. Bone marrow and/or peripheral blood stem cells were used as the stem cell source. Cyclosporin and prednisolone were used as prophylaxis against graft-versus-host disease (GVHD). The engraftment was monitored with cytogenetic/molecular analysis and change of blood group. Survival was calculated from the date of transplant to death or last follow-up. RESULTS: One hundred and fifty-four patients received allogeneic stem cell transplants from HLA-matched siblings for various hematological disorders at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan between July 2001 and September 2006. Indications for transplant included aplastic anemia (n=66), beta-thalassemia major (n=40), chronic myeloid leukemia (n=33), acute leukemia (n=8), and miscellaneous disorders (n=7). One hundred and twenty patients were male and 34 were female. The median age of the patient cohort was 14 years (range 1 1/4-54 years). One hundred and thirty-six patients and 135 donors were cytomegalovirus (CMV) IgG-positive. One hundred and forty patients (90.9%) developed febrile episodes in different phases of post-transplant recovery. Infective organisms were isolated in 150 microbiological culture specimens out of 651 specimens from different sites of infections (23.0% culture positivity). Post-transplant infections were confirmed in 120 patients (77.9%) on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections was 13.0%. Fatal infections included CMV disease (100% mortality, 6/6), disseminated aspergillosis (66.7% mortality, 4/6), pseudomonas septicemia (42.9% mortality, 9/21), and tuberculosis (25% mortality, 1/4). CONCLUSIONS: More than 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively, however CMV, aspergillosis, and pseudomonas infections remained problematic with high mortality. FAU - Ullah, Khalil AU - Ullah K AD - Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. dr_khalil58@yahoo.com FAU - Raza, Shahid AU - Raza S FAU - Ahmed, Parvez AU - Ahmed P FAU - Chaudhry, Qamar-Un-Nisa AU - Chaudhry QU FAU - Satti, Tariq Mahmood AU - Satti TM FAU - Ahmed, Suhaib AU - Ahmed S FAU - Mirza, Sajjad Hussain AU - Mirza SH FAU - Akhtar, Fahim AU - Akhtar F FAU - Kamal, Khalid AU - Kamal K FAU - Akhtar, Farrukh Mahmood AU - Akhtar FM LA - eng PT - Journal Article DEP - 20071024 PL - Canada TA - Int J Infect Dis JT - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JID - 9610933 RN - 0 (Anti-Inflammatory Agents) RN - 0 (Immunosuppressive Agents) SB - IM MH - Adolescent MH - Adult MH - Anti-Inflammatory Agents/administration & dosage MH - Child MH - Child, Preschool MH - Developed Countries MH - Female MH - Fungi/isolation & purification MH - Graft vs Host Disease/prevention & control MH - Gram-Negative Bacteria/isolation & purification MH - Hematologic Diseases/*therapy MH - Hospitals, Military MH - Humans MH - Immunosuppressive Agents/administration & dosage MH - Infant MH - Male MH - Middle Aged MH - Opportunistic Infections/epidemiology/*microbiology MH - Pakistan/epidemiology MH - Postoperative Complications/epidemiology/*microbiology MH - Proportional Hazards Models MH - Siblings MH - Stem Cell Transplantation/*adverse effects/methods MH - Survival Analysis MH - Transplantation, Homologous/adverse effects/methods MH - Viruses/isolation & purification EDAT- 2007/10/09 09:00 MHDA- 2008/09/23 09:00 CRDT- 2007/10/09 09:00 PHST- 2006/12/17 00:00 [received] PHST- 2007/06/15 00:00 [revised] PHST- 2007/06/23 00:00 [accepted] PHST- 2007/10/09 09:00 [pubmed] PHST- 2008/09/23 09:00 [medline] PHST- 2007/10/09 09:00 [entrez] AID - S1201-9712(07)00151-8 [pii] AID - 10.1016/j.ijid.2007.06.012 [doi] PST - ppublish SO - Int J Infect Dis. 2008 Mar;12(2):203-14. doi: 10.1016/j.ijid.2007.06.012. Epub 2007 Oct 24.