Preemptive therapy based on polymerase chain reaction for CMV DNA was associated with reduced risks for CMV disease, CMV-associated death, and TRM, whereas other prophylactic modalities did not give additional benefit.

Background Bloodstream infection (BSI) after allogeneic hematopoietic stem cell transplantation (HSCT) is a well‐known complication during the pre‐engraftment phase. Knowledge of trends in etiology and antibiotic susceptibility of BSI is important as the time to effective antibiotic treatment is closely associated with survival in bacteremic patients with septic shock. Methods BSI during the pre‐engraftment phase was studied retrospectively in 521 patients undergoing HSCT at our center in 2001–2008. Incidence, risk factors, outcome, and microbiology findings were investigated and compared with BSI in a cohort transplanted during 1975–1996. Results The incidence of at least 1 episode of BSI was 21%, the total attributable mortality of BSI was 3.3%, and crude mortality at day 120 after transplantation was 21%. The rate of gram‐positive and gram‐negative BSI was 80% and 13%, respectively. Gram‐negative BSI was more frequent both in 2001–2004 and in 2005–2008 compared with 1986–1996 (P = 0.023 for 2001–2004, P = 0.001 for 2005–2008), with fluoroquinolone‐resistant Escherichia coli as the predominant finding. BSI with viridans streptococci and E. coli occurred significantly earlier after HSCT than BSI with Enterococcus species, with median time of 4, 8, and 11 days, respectively (P < 0.01 both for viridians streptococci vs. Enterococcus species, and E. coli vs. Enterococcus species). Risk factors for BSI in multivariate analysis were transplantation from unrelated donor and cord blood as stem cell source, whereas peripheral blood as stem cell source was protective. Conclusions Despite low attributable mortality of BSI, crude mortality at day 120 after transplantation was 21%, indicating an association between BSI and other risk factors for death. The risk of gram‐negative BSI increased over time in parallel with an increased rate of quinolone resistance. However, the incidence and attributable mortality of gram‐negative BSI remained low. Thus, prophylaxis with ciprofloxacin is still deemed appropriate, but continued assessments of the risk and benefits of fluoroquinolone prophylaxis must be performed.

Summary:enza B-virus and parainfluenza virus are less common but can contribute to increased morbidity and mortality. 2-9 A mortality rate of up to 78% has been reported for RSV Treatment with ribavirin was instituted in 12 allogeneic and one autologous bone marrow transplant (BMT) infection and pneumonia in BMT recipients. 10 Ribavirin (1-␤-d-ribofuranosyl-1,2-triazole-3-carboxrecipients with proven respiratory syncytial virus (RSV), influenza B virus or parainfluenza virus infecamide) is a synthetic nucleoside analogue with broad spectrum and in vivo activity against RNA and DNA viruses. 11-tions. RSV was diagnosed in six cases, influenza B virus in four and parainfluenzavirus in three patients. Ribavi- 15 Currently, it is approved only as aerosol therapy in small children with severe RSV pneumonia, 16-17 but it is also rin was given orally or intravenously (15-20 mg/kg/day in three divided doses) and in nine cases with the being used widely in various clinical trials in chronic hepatitis C and HIV infection. Its mechanism of action in RSV addition of ribavirin inhalations (6 g/day). Three patients required ventilator support. Three out of seven infection appears to be interference, at the translatory level, with the expression of viral mRNA and viral proteins. patients with pneumonia, including one patient with RSV who developed pulmonary infiltrates 10 days afterOther possible mechanisms include decrease of intracellular levels of deoxyguanosine triphosphate and thereby inhithe start of therapy, died despite treatment with ribavirin (two RSV, one influenza B). Multiple etiological bition of viral enzymes such as RNA polymerases which has been shown for influenza C 1 virus. 14 There are no agents were found in the fatal cases. The clinical condition improved in 10 of 13 patients during therapy. No reports concerning systemic use of ribavirin in viral respiratory tract infections in BMT patients. serious adverse effects of systemic ribavirin were noticed. Two patients had reversible signs of hemolysis but only one patient required more erythrocyte transMaterials and methods fusions than expected after BMT. Obstructive respiratory distress was often observed (6/9 patients receiving Demography ribavirin inhalation therapy), which resulted in discontinuation of aerosolized therapy in four cases. Time to During the period 1988During the period -1994, treatment with ribavirin was engraftment (WBC Ͻ 0.2 × 10 9 /l) did not differ from instituted in 12 allogeneic and one autologous BMT other non-treated BMT patients. We conclude that ribapatients with proven viral respiratory tract infections. Six virin is well tolerated both orally and intravenously and were children (7 months to 10 years of age) and seven were it may, if instituted before development of hypoxia, adults (20-50 years of age). The indications for BMT were: reduce morbidity and mortality of RSV, influenza B and hematological malignancies (n = 11), malignant osteoparainfluenza in this group of patients. petrosis (n = 1) and Mb. San Filippo A (n = 1). A...

RSV infection results in a low overall attributable mortality after allo-HSCT, but progression of the infection to LRTI is associated with increased risk for death. Late respiratory dysfunction is more common among patients, experienced RSV infection compared with controls.