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Prevention of Nosocomial Infections in Marrow Transplant Patients: A Prospective Randomized Comparison of Systemic Antibiotics Versus Granulocyte Transfusions

Published online by Cambridge University Press:  02 January 2015

Finn B. Petersen ,
C.D. Buckner ,
Reginald A. Clift ,
Nira Nelson ,
George W. Counts ,
Joel D. Meyers  and
E.D. Thomas
Finn B. Petersen*
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
C.D. Buckner
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
Reginald A. Clift
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
Nira Nelson
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
George W. Counts
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
Joel D. Meyers
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
E.D. Thomas
Affiliation:
Fred Hutchinson Cancer Research Center, the Swedish Hospital Medical Centerand the University of Washington School of Medicine, Seattle, Washington
*
Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104.
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Abstract

One hundred twelve patients with hematologic malignancies underwent marrow transplantation from HLA-matched sibling donors and were randomized to receive either prophylactic granulocyte transfusions (PG, 67 patients) or prophylactic systemic antibiotics (PSA, 45 patients) as prophylaxis against nosocomial infections. Patients were treated in conventional hospital rooms and studied until day 100 post-transplant. For the entire study period, 26 patients (39%) in the PG group developed septicemia compared to 15 patients (33%) in the PSA group. Twenty-eight patients (42%) in the PG group developed local major infections compared to 19 patients (42%) in the PSA group. Ten patients (15%) in the PG group developed viral interstitial pneumonitis compared to 6 patients (13%) in the PSA group. None of these differences were statistically significant. There was no difference in the incidence of bacterial or fungal infections or viral interstitial pneumonitis between the two groups during the granulocytopenic or post-engraftment period. There was no difference in the incidence and severity of graft-versus-host-disease (GVHD). Inability to carry out the prophylaxis was frequent in the PG group, with complications necessitating discontinuance of transfusion in 24% of the recipients and 13% of the donors. The use of PG as an infection prophylaxis modality in marrow transplantation is not supported by this study, as it is difficult to carry out and because PG did not show any advantage over the use of PSA in preventing nosocomial infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 7 , Issue 12 , December 1986 , pp. 586 - 592
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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