High Incidence of Afebrile Bloodstream Infection Detected by Surveillance Blood Culture in Patients on Corticosteroid Therapy after Allogeneic Hematopoietic Stem Cell Transplantation

作者：Kameda Kazuaki; Kimura Shun ichi; Akahoshi Yu; Nakano Hirofumi; Harada Naonori; Ugai Tomotaka; Wada Hidenori; Yamasaki Ryoko; Ishihara Yuko; Kawamura Koji; Sakamoto Kana; Ashizawa Masahiro; Sato Miki; Terasako Saito Kiriko; Nakasone Hideki; Kikuchi Misato; Yamazaki Rie; Kanda Junya; Kako Shinichi; Tanihara Aki; Nishida Junji; Kanda Yoshinobu^*

来源：Biology of Blood and Marrow Transplantation, 2016, 22(2): 371-377.

DOI：10.1016/j.bbmt.2015.09.019

• Bloodstream infection
• Allogeneic hematopoietic stem cell transplantation
• Corticosteroid
• Surveillance blood culture

Bloodstream infections (BSI) are still important complications after allogeneic hematopoietic stem cell transplantation (allo-SCT). Patients who are receiving corticosteroid therapy can develop BSI without fever. The utility of surveillance blood cultures in these situations is controversial. We retrospectively analyzed 74 patients who received a corticosteroid consisting of >= 5 mg/kg prednisolone or equivalent after allo-SCT. In principle, we performed surveillance blood culture weekly for these patients. Sixteen patients (21.6%) developed definite BSI. In a multivariate analysis, a myeloablative conditioning regimen, high-risk disease status at allo-SCT, and the presence of a central venous catheter at the initiation of corticosteroid therapy were identified as independent significant risk factors for the development of definite BSI. At the first definite BSI episode, 7 patients (46.7%) were afebrile and diagnosed by surveillance blood culture. However, 6 of these 7 afebrile patients showed various signs that could be attributed to infection at the time of positive blood culture. In conclusion, patients receiving corticosteroid therapy after allo-SCT frequently develop afebrile BSI. Although surveillance blood culture might be beneficial in these situations, it also seems important to not miss the signs of BSI, even when patients are afebrile.

• 出版日期2016-2