RESUMO
BACKGROUND: The Karmanos Cancer Center Bone Marrow Transplant (KCC BMT) Center updated the vaccination protocol for transplant patients based on joint guidelines recently published by European Bone Marrow Transplantation, Centers for Disease Control, Infectious Diseases Society of America, and the American Society for Bone Marrow Transplantation. The objectives for this study were to determine the impact of vaccination cards and telephone outreach on vaccine adherence and to determine the reasons for missed or delayed vaccinations. METHODS: Retrospective analysis consisted of autologous and allogeneic hematopoietic stem cell transplant (HSCT) patients at the KCC BMT Clinic who received vaccines based on the guidelines published in 2009. Adherence was calculated as percentage of vaccines missed over the vaccination period. RESULTS: Overall, 37 of 111 patients (33%) missed at least 1 vaccine set and 29 patients (26%) received 1 set later than recommended. Reasons for missed and delayed vaccines included neutropenia/thrombocytopenia, anticoagulation, active infection, and graft-versus-host complications. CONCLUSIONS: Current guidelines recommend a complex vaccination schedule for the HSCT recipients, which may lead to difficulties with adherence. Our study shows that missed and delayed vaccinations are common in both autologous and allogeneic HSCT recipients. Methods to improve adherence are needed.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Cooperação do Paciente , Sistemas de Alerta , Vacinação , Anticoagulantes/uso terapêutico , Agendamento de Consultas , Feminino , Rejeição de Enxerto/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Esquemas de Imunização , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Projetos Piloto , Serviços Postais , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Telefone , Trombocitopenia/etiologia , Transplante Autólogo , Transplante HomólogoRESUMO
In this report, we describe a case of Rhodococcus equi lung infection diagnosed in an allogeneic hematopoietic stem cell transplant with oral graft-versus-host disease 3 months after stem cell infusion. The lung lesion persisted despite an approximate 3 months of vancomycin therapy, but then responded favorably to a combination of intravenous ertapenem at 1 g daily and oral rifampin at 600 mg daily for 1 month. An overview of Rhodococcus infection in transplant recipients is presented. This case and the discussed literature suggest that combination antibiotic therapy is warranted in patients with decreased humoral and cellular immunity.
Assuntos
Infecções por Actinomycetales/microbiologia , Doença Enxerto-Hospedeiro/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumopatias/microbiologia , Rhodococcus equi/isolamento & purificação , Infecções por Actinomycetales/diagnóstico por imagem , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Ertapenem , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Rifampina/uso terapêutico , Transplante Homólogo/efeitos adversos , beta-Lactamas/uso terapêuticoAssuntos
Deficiências do Desenvolvimento/sangue , Síndromes de Imunodeficiência/sangue , Purina-Núcleosídeo Fosforilase/deficiência , Erros Inatos do Metabolismo da Purina-Pirimidina/sangue , Ácido Úrico/sangue , Varicela/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Erros Inatos do Metabolismo da Purina-Pirimidina/enzimologia , Valores de Referência , SíndromeRESUMO
We performed a retrospective analysis of the medical records of allogeneic bone marrow transplantation (BMT) patients receiving cyclosporine plus an aminoglycoside and autologous BMT patients receiving an aminoglycoside without concurrent cyclosporine in the immediate post-transplant period. Acute nephrotoxicity was not seen in any of the patients. Concomitantly used agents such as acyclovir, vancomycin and amphotericin did not worsen renal function. The present study suggests that aminoglycosides, if carefully monitored, can be safely combined with continuous infusion of cyclosporine without excessive nephrotoxicity.