Multidrug‐resistant Enterobacteriaceae, <i><scp>P</scp>seudomonas aeruginosa</i>, and vancomycin‐resistant <i>Enterococcus</i>: Three major threats to hematopoietic stem cell transplant recipients

Satlin, Michael J.; Walsh, Thomas J.

doi:10.1111/tid.12762

Cited by 84 publications

(88 citation statements)

References 156 publications

(222 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Before the 1960s—an era without consistent empiric antibiotic treatment of febrile neutropenia—mortality rates for P aeruginosa BSI in neutropenic patients exceeded 60% . More recent studies have reported somewhat lower, but still unacceptably high mortality rates ranging from 9% to 41% for P aeruginosa BSI.…”

Section: Discussionmentioning

confidence: 99%

“…More recent studies have reported somewhat lower, but still unacceptably high mortality rates ranging from 9% to 41% for P aeruginosa BSI. This poor outcome may be partially explained by the expression of certain virulence factors as well as antibiotic resistance to one or multiple antibiotic classes …”

Section: Discussionmentioning

confidence: 99%

“…In the last decades, E faecium and vancomycin‐resistant enterococci (VRE) have gained importance as BSI pathogens in neutropenic patients with hematologic malignancies . Although considered a relatively avirulent pathogen, high 30‐day mortality rates between 18% and 38% in allo‐HSCT have been reported from both the United States and Europe without a clear association to vancomycin resistance .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Contribution of specific pathogens to bloodstream infection mortality in neutropenic patients with hematologic malignancies: Results from a multicentric surveillance cohort study

Kern¹,

Roth

Bertz

et al. 2019

Transplant Infectious Dis

View full text Add to dashboard Cite

Bloodstream infection (BSI) remains a serious complication in patients with hematologic malignancies and neutropenia. The risk factors for mortality after BSI and the contributions of BSI pathogens to mortality remain incompletely understood. We evaluated first BSI among adult neutropenic patients undergoing high-dose chemotherapy for hematologic malignancies in the setting of (a) an early disease stage of autologous (auto-HSCT) or allogeneic (allo-HSCT) hematopoietic stem cell transplantation or (b) for acute leukemia. Risk factors for intensive care admission and all-cause mortality were analyzed by multivariable logistic regression 7 and 30 days after onset of the first BSI in the first neutropenic episode. Between 2002 and 2015, 9080 patients met the study inclusion criteria, and 1424 (16%) developed BSIs, most of them during the first week of neutropenia. Mortality during neutropenia within 7 days and 30 days after BSI onset was 2.5% and 5.1%, respectively, and differed considerably between BSI pathogens. Both 7-day and 30-day mortalities were highest for Pseudomonas aeruginosa BSI (16.7% and 26.7%, respectively) and lowest for BSI due to coagulase-negative Staphylococcus spp. (CoNS) and Streptococcus spp.BSI pathogens were independently associated with 7-day mortality included P aeruginosa, Klebsiella spp., Enterobacter spp., Serratia spp., and enterococci. Only gramnegative BSI and candidemia were associated with admission to intensive care within 7 days after BSI onset. BSI caused by P aeruginosa continues to carry a particularly poor prognosis in neutropenic patients. The unexpected association between enterococcal BSI and increased mortality needs further study. K E Y W O R D Sbloodstream infection, hematopoetic stem cell transplantation, neutropenia

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Contribution of specific pathogens to bloodstream infection mortality in neutropenic patients with hematologic malignancies: Results from a multicentric surveillance cohort study

Kern¹,

Roth

Bertz

et al. 2019

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…41 With the emergence of ESBL-producing Enterobacteriaceae, carbapenems have been increasingly used against these organisms, leading to the emergence of carbapenemresistant bacteria. 42 Additionally to these classical bacteria, pathogens such as tuberculous and nontuberculous mycobacteria, or Nocardia can be significant pathogens in immunocompromised patients.…”

Section: Microbiologymentioning

confidence: 99%

Bacterial Pneumonias in Immunocompromised Patients

Louw

Mirouse

Peyrony

et al. 2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

With the overall improvement in survival of cancer patients and the widespread use of novel immunotherapy drugs for malignant as well as nonmalignant diseases, the prevalence of immunosuppression is rising in the population. Immunocompromised patients are particularly exposed to pulmonary infections which remain a leading cause for acute hypoxic respiratory failure and intensive care unit admission. Although fungal or opportunistic infections are always a concern, bacterial pneumonia remains the most common cause of pulmonary infection, is associated with a significant mortality, and has some specificity in this population. Adequate and timely prevention, diagnosis, and management of bacterial pneumonias require knowledge about the complex interplay between host factors (type and severity of immunosuppression) and bacterial pathogenesis, to improve the outcome. We provide an overview of bacterial pneumonias in immunocompromised patients including their epidemiology, risk factors with respect to the pattern of immunosuppression, microbiological characteristics, diagnostic approach, management, and prevention.

show abstract

“…carbapenem-resistant Pseudomonas aeruginosa 19 , and therefore represent a salient population for 60…”

mentioning

confidence: 99%

Widespread transfer of mobile antibiotic resistance genes within individual gut microbiomes revealed through bacterial Hi-C

Kent

Vill

Shi

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

12The gut microbiome harbors a 'silent reservoir' of antibiotic resistance (AR) genes that is thought to 13 contribute to the emergence of multidrug-resistant pathogens through the process of horizontal gene 14 transfer (HGT). To counteract the spread of AR genes, it is paramount to know which organisms harbor 15 mobile AR genes and with which organisms they engage in HGT. Despite methods to characterize the 16 bulk presence 1 , abundance 2 and function 3 of AR genes in the gut, technological limitations of short-read 17sequencing have precluded linking bacterial taxa to specific mobile genetic elements (MGEs) and their 18 concomitant AR genes. Here, we apply and evaluate a high-throughput, culture-independent method for 19surveilling the bacterial carriage of MGEs, based on bacterial Hi-C protocols. We compare two healthy 20individuals with a cohort of seven neutropenic patients undergoing hematopoietic stem cell 21 transplantation, who receive multiple courses of antibiotics throughout their prolonged hospitalizations, 22and are thus acutely vulnerable to the threat of multidrug-resistant infections 4 . We find that the networks 23 of HGT are surprisingly distinct between individuals, yet AR and mobile genes are more dispersed across 24 taxa within the neutropenic patients than the healthy subjects. Our data further suggest that HGT is 25occurring throughout the course of treatment in the microbiomes of neutropenic patients and within the 26 guts of healthy individuals over a similar timeframe. Whereas most efforts to understand the spread of AR 27genes have focused on pathogenic species, our findings shed light on the role of the human gut 28 microbiome in this process. 29 preferentially recruited to contigs that are longer and more abundant, but to a lesser degree than expected, 81reducing potential bias in our dataset toward highly abundant organisms (Extended Data Figure 4). We 82 binned contigs using several tools (Maxbin 22 , MetaBat and Concoct), and applied a binning aggregation 83 strategy, DAS Tool 23 , to obtain a set of draft genomic assemblies. As misassembly can resemble HGT, we 84removed assemblies with greater than 10% contamination, as determined by CheckM, resulting in 85 taxonomically coherent assemblies (Extended Data Figure 5), albeit a greater number of unbinned contigs 86(24.6% of the total) (Extended Data Table 3). We then apply conservative criteria to link mobile and 87 mobile AR-containing contigs with the genomic draft assemblies, considering an MGE part of a genome 88 assembly only if it is directly linked to it by at least two uniquely-mapped Hi-C read-pairs. As MGEs are 89 known to recombine, this mitigates the potential for falsely linking contigs that merely share common 90 mobile genes. However, this also potentially reduces our ability for overall detection, especially for larger 91MGEs, since mobile contigs are often fragmented in metagenomic assemblies 24 . Nevertheless, we 92restricted our analysis to those AR-organism and MGE-organism linkages derived from high-confidence ...

show abstract

Multidrug‐resistant Enterobacteriaceae, Pseudomonas aeruginosa, and vancomycin‐resistant Enterococcus: Three major threats to hematopoietic stem cell transplant recipients

Cited by 84 publications

References 156 publications

Contribution of specific pathogens to bloodstream infection mortality in neutropenic patients with hematologic malignancies: Results from a multicentric surveillance cohort study

Contribution of specific pathogens to bloodstream infection mortality in neutropenic patients with hematologic malignancies: Results from a multicentric surveillance cohort study

Bacterial Pneumonias in Immunocompromised Patients

Widespread transfer of mobile antibiotic resistance genes within individual gut microbiomes revealed through bacterial Hi-C

Contact Info

Product

Resources

About