Medical and Health Sciences

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Browsing Medical and Health Sciences by Author "Dwikat, Mayada Fahmi"

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    ANTIMICROBIAL PROPHYLAXIS AND THE RATE OF BLOOD STREAM INFECTIONS IN ADULT STEM CELL TRANSPLANTATION: A SINGLE CENTER RETROSPECTIVE STUDY FROM PALESTINE
    (An-Najah National University, 2025-11-13) Dwikat, Mayada Fahmi
    Introduction: Hematopoietic stem cell transplantation (HSCT), particularly autologous HSCT (auto-HSCT), has the potential to cure many hematologic cancers. However, infections continue to be a serious problem in this patient population, particularly bloodstream infections (BSIs), which are the leading cause of mortality and morbidity, primarily due to prolonged immunosuppression. Although antimicrobial prophylaxis is adopted as a standard procedure to minimize the infection risk in most HSCT centers, concern regarding antibiotic resistance and Clostridium difficile infection persists. Moreover, the burden of these infections in resource-limited settings like Palestine is insufficiently studied. Therefore, this study aims to describe the antimicrobial prophylaxis and determine the incidence rate and potential risk factors of BSI in adult patients undergoing auto-HSCT at An-Najah National University Hospital (NNUH), the only auto-HSCT center in Palestine. Methods: A retrospective observational cohort study was conducted at the bone marrow transplantation (BMT) department of NNUH between January 2018 and June 2024. The study analyzed extracted medical, laboratory, and pharmacy data from patients who underwent auto- HSCT. Descriptive statistics, univariate comparisons, and multivariate logistic regression to identify independent risk factors for BSIs and CDIs were performed using Statistical Package for Social Sciences (SPSS) version 21 software. Of the 267 candidates screened, 224 adult patients (aged ≥18 years) met the inclusion criteria and were included in the final analysis. Approval from the An-Najah National University Institutional Review Board (IRB) was obtained before initiating the study. Results: Among 224 patients, Multiple myeloma (MM) was the most commonly diagnosed malignancy, followed by Hodgkin Lymphoma (HL), accounting (50.4%,38.4%) respectively. Antimicrobial prophylaxis includes fluoroquinolones, with ciprofloxacin given to 31.3% of patients and levofloxacin administered to 69.2%. In addition, antifungal prophylaxis consisted of itraconazole (50.9%), fluconazole (48.7%), while antiviral prophylaxis with acyclovir was given to all patients. The incidence rate of BSI was 17.9% with gram-negative (GNB)and gram-positive bacteria (GPB) being the predominant isolates. Among GNB isolates, Escherichia coli was the most frequently detected organism (8 cases), while Staphylococcus epidermidis was the most common GPB, also identified in 8 cases. Extended-spectrum beta-lactamase (ESBL),and Klebsiella pneumoniae showed (100%) resistance to Ciprofloxacin. Moreover, Pseudomonas aeruginosa and Acinetobacter baumannii were classified as extensively drug-resistant bacteria (XDR) GNB. Most GPB are completely resistant to levofloxacin. Clostridioides difficile infection (CDI) occurred in 15.6% of cases, with Toxin A and Toxin B positivity in 14.3% and 10.3%, respectively. Oral vancomycin was the drug of choice for all patients diagnosed with CDI. Multivariate Logistic Regression revealed that patients with multiple myeloma had 2.7 times higher odds of developing BSI compared to those without MM. Furthermore, CHD showed a possible association with CDI (adjusted OR = 2.64, 95% CI: 0.83–8.37, p = 0.099). Despite infection risks, mortality was low (1.8%), and the average hospital stay was 24.7 ± 6.5 days. Conclusion: The use of antimicrobial prophylaxis among auto-HSCT in NNUH aligns with international guidelines. The incidence rate of BSI and CDI is consistent with studies worldwide. However, quinolone Resistance remains a significant concern in both gram-positive and gram-negative bacteria. Additionally, Multiple myeloma was identified as an independent risk factor for BSI. Finally, the emergence of multidrug-resistant organisms and CDI underscores the need for risk-adapted prophylaxis and strengthened infection control measures These findings provide valuable local data to inform clinical protocols and help reduce infection-related complications in HSCT settings, particularly in resource-limited environments