Experts from PGI conducted a study on the infection profile in its transplant centre, and found that bacterial and fungal infections were the major causes of prolongation of hospital stay.
The study, ‘Infections Are a Major Cause of Prolongation of Hospital Stay in Hematopoietic Stem Cell Transplants in Tropical, Developing Countries: Profile of a Transplant Centre in North India’, has been published in one of the scientific journals.
Conducted by Dr Deepesh P Lad, Dr Pankaj Malhotra, Dr Alka Khadwal, Dr Gaurav Prakash, Dr Pallab Ray, Dr Baijayantimala Mishra, Dr Chakrabarti Aranoloke and Subhash Varma, the study had data of the first 100 hematopoietic stem cell (blood cells that give rise to all other blood cells) transplants from 2004 -2014 being analysed. It included 36 allogeneic (when stem cells from another person are used) and 64 autologous (when a person’s own stem cells are used) transplants.
Apart from the infection attributed mortality being 9 per cent , the study found that infections were significantly more common in allogeneic (26/36) than autologous transplant recipients (34/64).
“There were 68 documented bacterial infections in 47 transplant recipients (47 per cent). Gram negative bacteria were the most frequent 49/68 (72.1 per cent), followed by gram positive bacteria 19/68 (27.9 per cent). Further, polymicrobial infections were seen in 11 patients (16.1 per cent),” reveals the study.
The diagnosis of fungal infections was made in 54 per cent cases and diarrhoea was seen in 59 per cent patients. Clostridium difficile (bacteria) toxin positivity was seen in 11.8 per cent and CMV (cytomegalovirus) infection was seen in 25 per cent of the allogeneic HSCT recipients.
All patients were on additional immunosuppression with corticosteroids.
All recipients received trimethoprim-sulphamethoxazole (antibiotic), levofloxacin (antibiotic), fluconazole (anti-fungal drug) and acyclovir prophylaxis (antiviral), voriconazole (antifungal).
Antifungals were started on day 3-5 and the median duration of antimicrobial usage was 13 days. Meanwhile, the median duration of hospital stay was 38 days,and the median day of neutrophil engraftment was 12 days.
The researchers suggest that the duration of antimicrobial use is associated with hospital stay.
“Bacterial and fungal infections were the major causes for prolongation of hospital stay in our centre (PGI). The incidence of possible fungal infections is higher than centres in other parts of the world and signifies the need for alternative detection methods to confirm the diagnosis”, the study concludes.
It further states, “whether the agent, host or environment factor in tropical and developing countries, contributes to this increased risk of infections, it needs to be evaluated in a prospective study”.