Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: importance of previous gut colonization

Bacteraemia in Haematopoietic Stem Cell Transplant Recipients in a Single Tertiary Referral Centre

“…Our observation concurred with findings from other HSCT centres reporting that bacteraemia occurs in approximately 13-60% of the HSCT recipients (Engelhard et al 1996;Ferreira 2018: Ustun 2018Mikulska 2018;Mikulska et al 2009;Wang et al 2015;Weisser et al 2017;Williamson et al 1999), particularly during the pre-engraftment phase (Almyroudis et al 2005;Ustun 2018). This is mainly due to neutropenia with a breakdown of mucosal barriers and presence of central venous catheter during the pre-engraftment phase (Sahin et al 2016;Tomblyn et al 2009).…”

“…Amongst GPB, the common isolation of CoNS was consistent with other studies (Chen et al 2010;Engelhard et al 1996;Gudiol et al 2014;Ninin et al 2001;Weisser et al 2017;Ferreira 2018;Mikulska 2018). The high frequency of CoNS in our study during the 5-year period was likely due to contamination rather than true bacteraemia because rigorous definition criteria of bacteraemia was applied.…”

“…Among HSCT recipients, the sources of most bacteraemia were the skin, oral mucosa and gastrointestinal tract (GIT). It is likely that oral mucosa or GIT has replaced the skin as a portal of entry of for bacteraemia, causing high GNB infection in our study (Mikulska et al 2009;Ferreira 2018). Apart from that, the absence of GPB isolates in 2015 probably due to enforcement of strict adherence to hand hygiene and proper infection control measures following renovation and implementation of antibiotic stewardship program in our HSCT ward in 2014.…”

Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

“…In one study of 232 patients undergoing HSCT, 6% were colonized with carbapenem-resistant K. pneumoniae at the time of transplant, and intestinal colonization with multidrug-resistant bacteria (vancomycin-resistant Enterococci and carbapenem-resistant Gram-negative bacteria) increased the risk of developing a multidrug-resistant bloodstream infection in the early posttransplant period. The authors of this study posit that gut decolonization could help reduce posttransplant multidrug-resistant bacteremia in HSCT recipients [112]. However, for SOT recipients, selective gut decontamination is not recommended and has been associated with the development of resistance to the antibiotic being used for decontamination [78,113].…”

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

“…The incidence of infections with multi-drug resistant organisms (MDROs) is increasing globally, and HSCT recipients are especially vulnerable, given their weaker immune systems [90,91]. A recent study of HSCT recipients found that 40.5% of patients are intestinally colonized with MDROs and 20% develop bloodstream infections with resistant organisms [92]. Infection with resistant organisms among HSCT recipients is associated with increased mortality [90,93].…”