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Bacterial infections in hematopoietic stem cell transplantation recipients

Mikulska, Małgorzataa,b; Del Bono, Valerioa; Viscoli, Claudioa,b

doi: 10.1097/MOH.0000000000000088
HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by Andrea Bacigalupo

Purpose of review Bacterial infections are among the most frequent complications of hematopoietic stem cell transplant (HSCT). This review describes current epidemiology and management of bacterial infections.

Recent findings Multidrug resistant (MDR) bacteria are increasingly frequent in HSCT recipients, but significant differences in etiology of bacterial infections and prevalence of resistant strains exist between different transplant centers. Methicillin-resistant coagulase-negative staphylococci, extended-spectrum beta-lactamase-producing Enterobacteriaceae, vancomycin-resistant enterococci and MDR Pseudomonas aeruginosa are the most relevant examples. Infection control measures are mandatory to limit the spread of resistant strains. Selective digestive decontamination is controversial and potentially associated with inducing resistance to antibiotics that might be the last treatment option, such as colistin or aminoglycosides. Empirical therapy should be individualized, and an escalation or de-escalation approach should be chosen depending on local epidemiology, colonization and clinical presentation. Antimicrobial stewardship, with the aim of improving management of bacterial infections, should be put in place in transplant units.

Summary Bacterial infections in the transplant population warrant currently particular attention to limit the negative impact of infections caused by resistant strains.

aDivision of Infectious Diseases, IRCCS San Martino University Hospital – IST

bDepartment of Health Sciences, University of Genoa, Genoa, Italy

Correspondence to Małgorzata Mikulska, MD, PhD, Division of Infectious Diseases, IRCCS San Martino University Hospital – IST, L.go R. Benzi, 10–16132 Genoa, Italy. Tel: +39 010 555 4654; fax: +39 010 3537680; e-mail: m.mikulska@unige.it

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins