ABSTRACT
To present our experience of post-transplant infections in allogeneic stem cell transplants at Sheikha Badryia Stem Cell Transplant Centre, Kuwait. Retrospective analysis of 21 consecutive patients with malignant and non-malignant hematological disorders who received a transplant of an unmanipulated bone marrow graft from an HLA-I identical sibling donor from November 2011 to December 2013. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. Bone marrow stem | cells were used as the stem cell source. Cyclosporin and methotrexate with or without mycophenolate mofetil / methylprednisolone were used as graft-versus-host disease [GVHD] prophylaxis. The engraftment was monitored with molecular analysis. Survival was calculated from the date of transplant to death or last follow-up. Twenty-one patients received allogeneic stem cell transplants from HLA- matched siblings for various hematological disorders. Twelve patients were female. The median age of the patient cohort was 34 years [range 3-41 years]. All patients and donors were cytomegalovirus [CMV] IgG-positive. Seventeen patients [80.95%] developed febrile episodes in different phases of post-transplant recovery. Post-transplant infections were confirmed in 20 patients [90.2%] on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections and chronic graft versus host disease was one patient [4.8%]. 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively
ABSTRACT
Over the last three decades a variety of drugs have been developed for treatment of candidal infections, of these azoles have achieved a great impact, but azole resistance have been recently implicated as a cause of treatment failure in patients with candidal infections. So, the aim of this study is to test resistance of candidal isolates of different clinical samples to azoles, and to test combined azole preparations to detect synergistic actions of such drugs when used topically or systematically. To achieve the aim, 123 clinically diagnosed cases of candidiasis were sampled, examined by DM, count culture and culture on SDA, the 90 yielded isolates were identified by rapid Candifast identification method. Azole resistance was tested by a resistogram microtube commercial method and also by YNB agar-azole diluted method for more accuracy. The tested azoles were Clotrimazole [CMZ], Ketoconazole [KTZ], Miconazole [MCZ], Econazole [ECZ], Itraconazole [ICZ], Tioconazole [TCZ] and Fluconazole [FCZ]. In addition to C. albicans, other Candida species now emerge as pathogens. Resistance to topically used and systemically used azoles is high. KTZ is the most effective one [16.7, 25.6 resistant strains by the 2 methods at 15.6 ug/ml]. Nearly 1/3 of strains were resistant to azoles used at 7.8 ug/ml concentrations. Many combined topical azoles showed synergistic effect while the only combination of systemically used azoles that showed synergism was KTZ+FCZ