Frequency and Pattern of Bacterial & Fungal Infections in Neutropenic Patients Undergoing Bone Marrow Transplantation

Abstract

Objective: To determine the frequency and pattern of bacterial & fungal infections in neutropenic patients undergoing bone marrow transplantation.

Methodology: The descriptive study was conducted in clinical hematology & stem cell transplant department, AFBMTC/NIBMT, Rawalpindi from 1/1/2019 to 31/12/2019. A total of 84 patients were observed. All patients were monitored six hours for neutropenic fever. Blood samples were taken with aseptic technique for bacterial & fungal cultures in these patients. Serum galactomannan and beta-D glucan tests were carried out in patients with suspected fungal infection. Chest X-Ray was done for lower respiratory tract infection. These infections were categorized as primary bloodstream infections or secondary bloodstream infections as per operational definitions.  Data was analyzed using SPSS version 22.

Results: Out of the 84 patients, 68 (80.9%) patients fulfilled the criteria for primary or secondary bloodstream neutropenic infections. The median age of the study population was 8 years (SD ± 1.25). Seventy-one percent of patients were male and 29% of patients were female. Ninety-three percent of patients had a bacterial infection, while 7% of patients had a fungal infection. Fifty-six patients had primary bloodstream infections while 12 patients had secondary bloodstream infections. Klebsiella pneumoniae, Pseudomonas aeruginosa & Stenotrophomonas maltophilia were the most common bacteria isolated from cultures. Out of 12 patients who had secondary bloodstream infections, 8(12%) patients had radiological findings (consolidations, opacities) while 4(6%) patients had positive serum galactomannan.

Conclusion: Our study concludes that bacterial infections are more common than fungal infections in neutropenic patients undergoing bone marrow transplantation. Klebsiella pneumonia is the most common pathogen in pre-engraftment neutropenic phase.