抄録
Bone marrow transplantation was performed on 68 patients with severe hematologic disorders and solid tumors on the total protective environment program using laminar-airflow isolation and decontamination procedures. Patients were evaluated for infection acquisition while isolated. Sixty-four patients (94%) became febrile after the conditioning treatment, but evidence of infection proved absent in 23 (36%) of them. Viral infection occurred in 30 patients (44%), bacterial infection in 17 patients (25%), and fungal infection in 1 patient (1%). The infectious complications included orolabial herpes simplex (28 patients), septicemia (11 patients), local catheter infection (6 patients), anoperineal cellulitis and periodontitis (5 patients each), viral interstitial pneumonia (3 patients), and herpes zoster, bacterial pneumonia, and dacryocystitis (1 patient each). The most common causative bacteria, Pseudomonas aeruginosa and Staphylococcus epidermidis, tended to be isolated as a monoflora or a pure culture from the throat and/or stool or infection sites just before or at the onset of fever. Five patients (7%) died of infection while isolated. Anoperineal cellulitis with or without bacteremia proved fatal in 4 patients, of whom 3 had become febrile within the 2 weeks before transplant. It was, thus, suggested that the strict enforcement of prophylactic measures based on the results of surveillance cultures may be associated with a reduced incidence of septicemia, hence reduced mortality. In addition, it was stressed that scrutiny of residual infections such as seen in periodontal and anorectal areas before transplant will reduce serious bacterial infection soon after transplant.
