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Cord Blood Stem Cells

Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 46, pages 208–216 (2011)Cite this article

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Abstract

Although fluoroquinolones or other antibiotics are commonly used to prevent bacterial infections after hematopoietic cell transplantation (HCT), because of the growing presence of multidrug-resistant microorganisms, it is important to identify patients who are more likely to benefit from antibacterial prophylaxis. To evaluate risk factors for early bacterial infection after allogeneic HCT, we retrospectively analyzed clinical data for 112 consecutive adult patients with hematological malignancies who received transplants without any antibacterial prophylaxis. The cumulative incidence of bacterial infection at 30 days after transplantation was 16%. Among various pre-transplant factors, only high serum ferritin (>700 ng/mL, 47 patients) and high C-reactive protein (CRP) (>0.3 mg/dL, 28 patients) levels were significantly associated with the development of bacterial infection in a multivariate analysis (hazard ratio (95% confidence interval): ferritin, 4.00 (1.32–12.17); CRP, 3.64 (1.44–9.20)). In addition, septic shock and sepsis with organ failure were exclusively observed in patients who had high ferritin and/or high CRP levels. These results suggest that pretransplant serum ferritin and CRP levels can be useful markers for predicting the risk of early bacterial infection after allogeneic HCT. It may be prudent to limit antibacterial prophylaxis to patients with predefined risk factors to ensure the safety of HCT with the use of fewer antibiotics.

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Acknowledgements

We are grateful to Rie Goi and Mika Kobayashi for their expert data management and secretarial assistance, and to all of the members of the transplant and infection-control teams at Kyoto University Hospital for their dedicated care of the patients and donors.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    J Kanda, C Mizumoto, T Ichinohe, H Kawabata, K Yamashita, T Kondo, T Uchiyama & T Ishikawa

  2. Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    T Saito, S Takakura & S Ichiyama

  3. Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan

    T Uchiyama

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  1. J Kanda
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Correspondence to J Kanda.

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Kanda, J., Mizumoto, C., Ichinohe, T. et al. Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 46, 208–216 (2011). https://doi.org/10.1038/bmt.2010.108

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