Bacterial pneumonia in recipients of bone marrow transplantation: A five-year prospective study

Izidore S. Lossos, Raphael Breuer, Reuven Or, Nurith Strauss, Hanita Elishoov, Elizabeth Naparstek, Memet Aker, Arnon Nagler, Allon E. Moses, Mervyn Shapiro, Shimon Slavin, Dan Engelhard*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

90 Scopus citations


Bacterial pneumonia as an important complication of bone marrow transplantation (BMT) has not been subjected to comprehensive analysis. Two hundred fifty-five consecutive allogeneic and autologous BMT recipients, ranging in age from 1 month to 53 years, were prospectively followed for 3 days to 3 years (median, 108 days) for development of bacterial pneumonia. Etiology, place acquired, chest radiography, and outcome were recorded and the association between bacterial pneumonia and demographic and clinical variables was analyzed. Thirty-seven (15%) patients experienced 52 episodes of bacterial pneumonia: Onset of 13 episodes occurred within 30 days after transplantation, 10 episodes occurred on days +31 to +100, and 29 episodes occurred thereafter. Bacterial pneumonia was the terminal event or contributed to fatal outcome in 8 patients (22% of bacterial pneumonia cases, 3% total study population). Mortality due to hospital-ac-quired pneumonia (6/21) was significantly higher than mortality due to community-acquired pneumonia (2/31) (P=0.03). Bacterial pathogens were identified in 27 (52%) episodes. During the first 100 days after BMT, hospital-acquired Gram-negative bacteria predominated, caused mainly by Pseudomonas aeruginosa, Klebsiella pneu-moniae, Acinetobacter Iwoffi, and Enterobacter cloacae. After day +100, community-acquired, Gram-positive bacteria predominated, particularly Streptococcus pneumoniae. Haemophilus influenzae occurred periodically. Considering all episodes, significant association was found between bacterial pneumonia and veno-oc-clusive disease (VOD) (P<0.01) and chronic graft-versus-host disease (GVHD) (P<0.02). For culture-positive episodes, the association between bacterial pneumonia and VOD was significant (PcO.OOl) and borderline for acute GVHD (P=0.07). It is concluded that VOD and GVHD are positively associated with post-BMT bacterial pneumonia. Its incidence, etiology, risk factors, and outcome are important considerations in its prevention and treatment.

Original languageEnglish
Pages (from-to)672-678
Number of pages7
Issue number7
StatePublished - Oct 1995
Externally publishedYes


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