Intestinal Colonization with Carbapenem-Resistant Enterobacteriaceae in Acute Leukemia Patients: Risk Factors and Molecular Characteristics

Abstract

Background Carbapenem-resistant Enterobacteriaceae (CRE) colonization is associated with bacterial translocation, which can result in subsequent endogenous CRE infection. In the present study, we aim to investigate the colonization-related risk factors and molecular epidemiological characteristics of CRE in patients with acute leukemia. Methods From January 2021 to December 2021, acute leukemia patients were screened for CRE by fecal/perianal swabs. We identified the species, carbapenemase-encoding genes, and virulence genes of the colonizing strains and performed antimicrobial susceptibility tests and ERIC-PCR typing. Risk factors for CRE colonization were identified by univariate and multivariate analysis. Results We collected a total of 21 colonizing strains from 320 patients. All strains were resistant to meropenem. Klebsiella pneumoniae was the most abundant species, and ERIC-PCR typing showed low diversity. Univariate analysis showed that age, cephalosporins, penicillins, tigecyclines, and hematopoietic stem cell transplantation status were risk factors for CRE colonization; simultaneously discovered CRE strains played a dominant role in invasive infection of colonized patients. Logistic multivariate regression analysis showed that age, cephalosporins, and tigecyclines were independent risk factors for CRE intestinal colonization. Conclusion CRE colonization can increase the incidence of CRE infection in patients with acute leukemia. Early detection of CRE colonization through CRE screening is an important measure to control the spread of CRE.

Risk factors and molecular epidemiology of intestinal colonization by carbapenem-resistant Gram-negative bacteria in patients with hematological diseases: a multicenter case‒control study

“…However, the rate in China was lower than the rate of 75.5% reported in India ( 14 ). Additionally, single-center studies in China have reported CRE colonization rates ranging from 6.6% to 23.8% in patients with hematologic malignancies ( 15 , 16 ). Among all colonized CR-GNB isolates, CRE colonization accounted for the highest, followed by CRPA, while CRAB colonization was rare.…”

Colonization with Carbapenem-Resistant Enterobacteriaceae Contributes to Unfavorable Outcomes in End-Stage Liver Disease Patients

“…Many previous studies on CRE colonization have focused on hematologic diseases and ICU populations, and the results have varied widely. For example, CRE colonization rates were reported as 1.5–75.5% in hematological malignancy patients [ 17 , 20 ]. CRKP is the most common CRE species [ 21 ].…”

“…Furthermore, colonization could be an important source of transmission. Active screening for CRE colonization will help control its spread [ 16 , 17 , 18 ]. A German study showed that colonization with MDR bacteria increases mortality in patients with ESLD [ 19 ].…”

Metagenomic Next-Generation Sequencing (mNGS) for the Timely Diagnosis of Carbapenem-Resistant Klebsiella pneumoniae in Leukemia Patients

“…CRE intestinal colonization can increase the incidence of CRE infection in patients with acute leukemia [ 11 ]. CrKP accounts for approximately 60% of CRE infections in China [ 12 ].…”