{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T17:25:13Z","timestamp":1791134713635,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T00:00:00Z","timestamp":1394668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2014,4]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n In the 1960s, it was reported that infectious complications were the main cause of fever during neutropenia that followed hematopoietic stem cell transplant (\n HSCT<\/jats:styled-content>\n ). More recently, mucositis has become recognized as an important determinant of the inflammatory response and infectious complications.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The objective of this prospective study was to determine the impact of intestinal mucositis, as measured by plasma citrulline, and neutropenia on the systemic inflammatory response (C\u2010reactive protein) and the occurrence of bacteremia among 2 cohorts of\n HSCT<\/jats:styled-content>\n recipients: 1 composed of 18 patients who had been treated with a myeloablative (\n MA<\/jats:styled-content>\n ) regimen (high\u2010dose melphalan) and the other involving 19 patients who had received the non\u2010myeloablative (\n NMA<\/jats:styled-content>\n ) regimen (fludarabine and cyclophosphamide). Blood cultures were obtained for surveillance from admission onwards as well as at the onset of fever.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The\n MA<\/jats:styled-content>\n regimen induced severe intestinal mucositis manifest by citrullinemia <10\u00a0\u03bcmol\/L, which was accompanied by an inflammatory response, and bacteremia affected 8 (44%) of 18 patients and coincided with the nadir of citrullinemia. By contrast, those who had been treated with the\n NMA<\/jats:styled-content>\n regimen did not develop severe intestinal mucositis, had a moderate inflammatory response, and only 2 (11%) of the 19 patients developed bacteremia. However, both groups experienced profound neutropenia and its duration was significantly longer for those receiving the\n NMA<\/jats:styled-content>\n regimen.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study suggests that severe intestinal mucositis, i.e., citrullinemia <10\u00a0\u03bcmol\/L, defines the period of risk of bacteremia better than does neutropenia, and that measuring plasma citrulline may prove useful in deciding who needs empirical antimicrobial therapy and when.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/tid.12195","type":"journal-article","created":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T03:49:00Z","timestamp":1394682540000},"page":"279-285","source":"Crossref","is-referenced-by-count":69,"title":["Mucositis not neutropenia determines bacteremia among hematopoietic stem cell transplant recipients"],"prefix":"10.1111","volume":"16","author":[{"given":"A.H.E.","family":"Herbers","sequence":"first","affiliation":[{"name":"Department of Hematology Nijmegen Institute for Infection, Inflammation and Immunity (N4i) Radboud University Nijmegen Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.F.J.","family":"de Haan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and HTA Nijmegen Institute for Infection, Inflammation and Immunity (N4i) Radboud University Nijmegen Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.J.F.M.","family":"van der Velden","sequence":"additional","affiliation":[{"name":"Department of Hematology Nijmegen Institute for Infection, Inflammation and Immunity (N4i) Radboud University Nijmegen Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.P.","family":"Donnelly","sequence":"additional","affiliation":[{"name":"Department of Hematology Nijmegen Institute for Infection, Inflammation and Immunity (N4i) Radboud University Nijmegen Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.M.A.","family":"Blijlevens","sequence":"additional","affiliation":[{"name":"Department of Hematology Nijmegen Institute for Infection, Inflammation and Immunity (N4i) Radboud University Nijmegen Medical Centre Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,3,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.07.004"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-64-2-328"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2010.10.013"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02770834"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2000.02202.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1318"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(03)00170-7"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704563"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2008.270"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2008.170"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0015156"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.06.019"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-120-10-199405150-00004"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/161.3.397"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19980601)82:11<2275::AID-CNCR25>3.0.CO;2-Q"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2005.10.007"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0506655103"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.9.1845"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1705686"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp596"}],"container-title":["Transplant 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