Early gram-positive bacteremia in BMT recipients: impact of three different approaches to antimicrobial prophylaxis.

Arns da Cunha C, Weisdorf D, Shu XO, DeFor T, Pastor JD, Johnson JR
Bone Marrow Transplant. 1998 21 (2): 173-80

PMID: 9489635 · DOI:10.1038/sj.bmt.1701057

Antimicrobial prophylaxis against gram-positive bacteremia (GPB) following BMT may prevent infections but promote antimicrobial resistance. In a sequential cohort study involving 289 consecutive BMT recipients we compared three protocols for prevention of GPB (vancomycin prophylaxis, penicillin/cefazolin prophylaxis, and no specific GPB prophylaxis) with respect to incidence of GPB, mortality, and vancomycin use. GPB was associated with increased mortality (27% vs 15%; P = 0.02), but contributed to only five of 52 deaths in the study population, and only one of 15 subjects with viridans streptococcal bacteremia developed fatal septic shock. Vancomycin prophylaxis reduced the incidence of GPB (11%) compared to penicillin/cefazolin (27%) or no prophylaxis (40%) (all P < 0.03), but did not significantly reduce mortality. The incidence of fungemia, gram-negative bacteremia, and infection-associated mortality was unaffected by GPB prophylaxis. Vancomycin use was substantially greater in the vancomycin prophylaxis group. We conclude that in comparison with vancomycin prophylaxis, BMT support regimens that do not include vancomycin prophylaxis allow reduced overall vancomycin use without an apparent increase in early post-BMT mortality, despite the greater associated frequency of GPB.

MeSH Terms (22)

Adolescent Adult Aged Anti-Bacterial Agents Bacteremia Bone Marrow Transplantation Cefazolin Child Child, Preschool Cohort Studies Drug Resistance, Microbial Drug Therapy, Combination Female Gram-Positive Bacterial Infections Humans Infant Male Middle Aged Penicillins Streptococcal Infections Time Factors Vancomycin

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