Clinical and microbiological retrospective evaluation of febrile neutropenia attacks developing at early stage after transplantation i̇n patients with hematological malignitia who received allogenic bone marrow transplant

İnfections after hematopoietic stem cell transplantation (HSCT) are a major risk factor for morbidity and mortality and are a common complication in the early stages. Our study aims to provide a basis for clinical and microbiological examination of febrile neutropenia attacks developing in the early period after allogeneic HSCT, investigating the epidemiological features and risk factors of infections, and thus to guide diagnosis and treatment as early as possible before signs of infection appear. A total of 133 patients who underwent allogeneic HSCT between June 2011 and March 21 at Bursa Uludağ University Faculty of Medicine, Department of Hematology Stem Cell Transplantation Unit were retrospectively analyzed. Febrile neutropenia (FEN) was observed in 115 (86.5%) patients. While the risk of developing FEN did not differ according to gender, age and comorbid disease status, it differed according to the diagnosis of the primary disease (p=0.040). Especially in patients diagnosed with ALL, FEN development was observed at a higher rate than patients with aplastic anemia. On the other hand, the rates of FEN development were significantly higher in patients with grade III-IV mucositis, development of acute GVHD and related steroids. Of all FEN attacks, 33% were evaluated in the MTI (microbiologically proven infection), 46.2% in the KTI (clinically proven infection) and 20.8% in the FUO (fever of unknown origin) category. When the relationship between transplant variables and reproduction in the cultures of the patients was examined, it was seen that the growth rate of gram-negative bacteria in the peripheral blood culture was higher in women than in men. However, the rate of gram-negative bacteria growth in blood and catheter cultures was higher in patients with a history of hypertension. The rate of growth in blood cultures taken from the periphery and the catheter was 23.4% and 16.5%, respectively, and gram positive (GP) growth was found in 59.4%-70% and gram-negative (GN) growth in 40.5%-30%, respectively. The most common GP bacterial agent was Coagulase-negative staphyolococcus (CNS) growth, with a rate of 59.4% and 66.6%, respectively. Escherichia coli (E.coli) was the most common cause of GN, with a rate of 73.3% and 66.6%, respectively. Growth was detected in 8.6% of the urine cultures, and all gram-negative bacteria and the most common E.coli growth were detected. Contrary to what is known, the relationship between prolonged neutropenia (≥21 days) and the depth of neutropenia with FEN development and culture growth could not be demonstrated. İn conclusion, due to the critical effects of patient management on mortality and morbidity in FEN attacks, it is of great importance that the patient characteristics and risk factors are well known, that centers closely monitor their own microorganism profile and that they create a treatment protocol.