INFECTIONS IN BONE-MARROW TRANSPLANT RECIPIENTS
INFECTIONS IN BONE-MARROW TRANSPLANT RECIPIENTS
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DOI：
10.1093/clinids/18.3.273
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发表时间：
1994-03-01
影响因子：
11.8
通讯作者：
DONOWITZ, GR
中科院分区：
文献类型：
--
作者：
SABLE, CA;DONOWITZ, GR
1993年，全世界进行了15，000例同种异体和自体骨髓移植（M。Bortim，国际骨髓移植登记处，密尔沃基;个人交流）。移植已越来越多地用于治疗恶性和非恶性血液病、实体瘤、代谢和遗传疾病。感染和移植物-vs.-宿主疾病（GVHD）仍然是骨髓移植受者发病率和死亡率的主要来源。感染的发生是骨髓移植引起的可预测的、连续的宿主防御抑制的直接结果（表1）。感染的严重程度和类型还取决于许多其他因素，包括移植物类型、组织相容性错配的存在和程度、T淋巴细胞操作（耗竭）、移植物类型与采用的宿主预防、GVHD的严重程度以及移植前发生的病毒和真菌感染。以前的抗生素暴露，包括抗生素预防，也可能有助于确定发生的感染，虽然认为特定感染只发生在移植过程中的特定时间过于简单化，但将移植过程分为特定阶段是有帮助的，每个阶段的特征是特定的宿主防御缺陷，并与特定的感染组相关。
In 1993,, 15,000 allogeneic and autologous bone marrow transplantations were carried out worldwide (M. Bortim, International Bone Marrow Transplant Registry, Milwaukee; personal communication). Transplantation has been utilized with increasing frequency for treatment of ma-lignant and nonmalignant hematologic diseases, solid tumors, and metabolic and genetic disorders. Infection and graft-vs.-host disease (GVHD) remain the major sources of morbidity and mortality in recipients of bone marrow transplants. Infections occur as a direct result of the predictable, sequential suppression of host defenses that is caused by marrow transplantation (table 1). The sever-ity and type of infection also depend on a number of other factors including the type of transplant, the presence and degree ofhistocompatibility mismatch, T lymphocyte manip-ulation (depletion), type of graft-vs.-host prophylaxis employed, severity of GVHD, and viral and fungal infections occurring before transplantation. Previous antibiotic exposures, including antibiotic prophylaxis, may also help to de-fine the infections that develop.While it would be overly simplistic to suggest that specific infections occur only at specific times in the transplantation process, it is nevertheless helpful to divide the transplanta-tion process into specific phases, each of which is characterized by specific host defense defects and is associated with a specific group of infections.