ABSTRACT
Registry data estimate that 17 000 allogeneic and over 30 000 autologous hematopoietic stem cell transplants (derived from blood or bone marrow) were performed in North America in 1998.1 Allogeneic transplants are often complicated by graft-versus-host disease (GVHD), organ toxicity, and infections, resulting in an early mortality ranging from 10%–40%, depending on the risk of the underlying disease. Early mortality associated with unrelated transplant is even higher. The primary disease is the most common cause of early mortality following a related allogeneic transplant, but GVHD and infection each account for 20% of the deaths. Improvements in the management of infectious disease, timeliness of engraftment, and limitation of regimen-related toxicity have allowed older patients to be transplanted, and have moved the setting of transplant care to outpatient or treatment center areas. These advances and changes in the transplant population and setting in the past decade have influenced the incidence and types of infectious complications encountered after transplant. The approach to the prevention and management of infectious complication should be tailored to the transplant population, considering characteristics such as age, type of transplant, and treatment regimen. Unit-specific data on incidence of infections and susceptibility patterns of the organisms should also be considered in the overall approach.
