gms | German Medical Science

Introduction: While Hematopoietic Stem Cell Transplantation (HSCT) has been widely applied to treat oncological and hematological diseases, it is crucial to improve patients’ survival rate by reduction of infectious complications after treatment. Thus identifying risk factors contributed to the infection becomes the interest of research.

This is a cross-sectional study on patients who underwent autologous HSCT in a German educational hospital from 2005 to 2008. Patient profile included information such as age, gender, underlying disease, duration of neutropenia, cause of fever, degree of diarrhea, response to therapy and mucositis etc. Descriptive information of the group was first calculated along with the relationships between age and underlying disease and responding rate to antibiotics. Associated risk factors with infection and conditions to respond to antimicrobial were evaluated in order to further improve patients’ outcome.

Methods: Patient records were evaluated regarding their infection profile and associated independent variables. Relationships between categorical data and qualitative data were tested by using Kruskal Wallis test because of the unbalanced observations in each category. The outcome is dichotomous, i.e. infection or no infection, thus logistical regression analysis was applied. With no knowledge which independent variable would be significant, plus the large number of independent variables, a forward selection logistical regression analysis was used.

Odd ratios were further calculated at each level after identifying the factors. The significance level of all tests was set at 0.05 and performed by the commercially available computer software SAS (version 9.3, SAS institute).

Results: In total there were 197 records for 141 patients because some patients had more than once transplantations. Fever occurred in 86.5% of patients. 48.8% febrile episodes were classified as fever of unknown origin and 51.2% as having clinically or microbiologically documented infection Overall mortality rate was 3% among the patients especially patients with pneumonia had a poor prognosis.

Severe mucositis (Grade III and IV) and severe diarrhea (Grade III and IV) were identified as the most important factors for the occurrence of an infection.

The respond rate to antimicrobial treatment depended significantly on fever with unknown origin (FUO) and the length of the neutropenia. In patients with FUO, the antimicrobial therapy was more successfully than in patients with documented infections. For patients with neutropenia less than 10 days, the antimicrobial therapy was more successfully than in patients with neutropenia longer than 10 days.

Discussion: According with other researchers age [1], [2] and underlying disease [1] are not related to the risk of infection. This study agreed that age is not a risk factor but showed that patients with severe mucositis or diarrhea are at the highest risk to develop an infection. The response to antimicrobial therapy is better in patients with fever of unknown origin and shorter duration of neutropenia.