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. 2010 Sep 21;5(2):Doc06.
doi: 10.3205/dgkh000149.

Aminoglycoside-free interventional antibiotic management in patients undergoing haemopoietic stem cell transplantation

William H Krüger  1 , Thomas Kiefer, Georg Daeschlein, Ivo Steinmetz, Axel Kramer, Gottfried Dölken
Affiliations

Aminoglycoside-free interventional antibiotic management in patients undergoing haemopoietic stem cell transplantation

William H Krüger et al. GMS Krankenhhyg Interdiszip. .

Abstract
in English, German

The position of aminoglycosides within interventional antibiosis in the early phase after stem cell transplantation has not been fully clarified so far although their use can induce serious renal impairment. To investigate this question early-infection data from 152 patients undergoing 195 allogeneic and autologous stem cell transplantations were investigated. Prophylaxis and treatment of infections followed international standards; however, aminoglycosides were omitted to avoid additional risks such as ototoxicity and nephrotoxicity and increased selection of resistant pathogens. Costs were another aspect.The overall-incidence of infections was 78% (152/195) and 67 patients showed more than one episode of infection. Fever of unknown origin and bacteriaemia/septicaemia dominated the spectrum of infections. The overall-response to interventional regimen consisting of β-lactam or carbapenem plus glycopeptides was 48%. Aminoglycosides were given in three patients in the late course of disease. Overall mortality was 15/195 (7.7%) and clearly related to infection in nine cases mostly due to mould infection. A comparison with previous published literature showed no hint for inferiority of 'aminoglycoside-free' antibiotic management in stem cell transplant patients. In conclusion, the present analysis supports the policy to omit aminoglycosides in the therapy of early infections in patients undergoing stem cell transplantation to avoid additional toxicity.

Die Bedeutung der Aminoglycoside für das empirische antibiotische Management in der Frühphase nach Stammzelltransplantation ist mit Ausnahme des Risikos schwerer Nierenschäden nicht vollständig geklärt. Zur Klärung dieser Frage wurden die Daten der Frühinfektion von 152 Patienten mit 195 allogener und autologer Stammzelltransplantation analysiert. Die Prophylaxe und Therapie der Infektionen erfolgte gemäß internationalen Standards mit der einzigen Ausnahme, dass auf den Einsatz von Aminoglycosiden verzichtet wurde, um ototoxische und nephrotoxische Risiken zu vermeiden und dem Selektionsdruck mit Verbreitung resistenter Erreger zu begegnen. Die Einsparung von Kosten war ein zusätzlicher Aspekt.

Die Inzidenz der Frühinfektion betrug 78% (152/195). 67 Patienten waren von mehr als einer Infektionsepisode betroffen, wobei Fieber unklarer Genese und Bakteriämie/Septikämie dominierten. Auf das interventionelle Regime mit β-Lactam oder Carbapenem + Glyopeptide reagierten 48% der Patientrn. Aminoglycoside wurden nur bei drei Patienten in der Spätphase der Erkrankung verabfolgt. Die Mortalität betrug 15/195 (7,7%) und war in neun Fällen eindeutig mit der Infektion, meist verursacht durch Schimmelpilze, assoziiert. Der Vergleich mit der Literatur ergibt keinen Anhalt für eine Unterlegenheit des Aminoglycosid-freien Antibiotika-Managements für Patienten mit Stammzelltransplantation. Damit stützt die vorliegende Studie die Möglichkeit des Verzichts auf Aminoglycoside in der Therapie der Frühinfektion von Patienten mit Stammzelltransplantation zur Vermeidung toxischer Risiken.

Keywords: conditioning therapy; high-dose therapy; infection; neutropenia; stem cell transplantation.

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Figures

Table 1
Table 1. Diagnoses
Table 2
Table 2. Primary and subsequent infections. Percentages in last column are related to n=152 patients with any first infection listed in the second column.
Table 3
Table 3. Isolated microbial pathogens
Table 4
Table 4. Response to antimicrobial therapy. N=40 patients without antimicrobial were not included in this analysis.
Table 5
Table 5. Deaths during early phase of transplantation
Table 6
Table 6. Studies investigating early infections in transplant patients
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