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13. Infections following haematopoietic stem cell transplant are generally similar to that in the solid organ transplant setting.

a. In addition to the usual bacterial, fungal infections and viral infections especially CMV reactivation and parasitic
infections e.g. Pneumocystis jiroveci (PJP) and toxoplasma infection can occur.

b. It is recommended that prophylactic use of ganciclovir or pre-emptive monitoring for CMV reactivation should be carried
out during the first 100 days.

c. Trimethoprim/sulfamethoxazole (80/400mg) once daily is extremely effective in the prevention of PJP or toxoplasmosis.

a. It is recommended that these measures be continued in patients with active graft-vs-host disease and in those remaining
on high dose immunosuppressive agents.

14. Attention must be paid to:

a. Strict isolation measures with good personal hygiene and diet.
b. Modification of antibiotic regimen if deterioration of clinical status
c. The antibiotics are generally kept for a minimal duration of 5 to 7 days or stopped if afebrile for 3 days in patients with
improving neutrophil counts
d. Regular culture and surveillance
e. HANDWASHING and strict aseptic technique
f. Venous cannula must be inspected daily for signs of phlebitis and changed every 72h or when necessary. Central
devices are to be removed if there is clinical deterioration in spite of appropriate antibiotics for 48-72h

References:

1. Bohlius J, Herbst C, Reiser M, Schwarzer G, Engert A. Granulopoiesis-stimulating factors to prevent adverse effects in the treatment of malignant
lymphoma. Cochrane Database of Systematic Reviews 2008, Issue 4.
2. Alison GF, Eirc JB, Kent A S et al. IDSA guideline : Clinical Practice guideline for the Use of Antimicrobial Agents in Neutropenic Patients with cancer
:2010 update by the Infectious Diseases Society of America . CID 2011; 52: 56-93.
3. Diana A, ChristinaO, Catherine C et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing
th
resistance: summary of the 2011 4 European conference on the infections in Leukaemia. Haematologica 2013;98(12) :1826-1835

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