The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients

Abstract

Objective:Patients receiving hematopoietic stem cell transplantation (HSCT) are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs) are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively.Materials and Methods:The epidemiological properties of 312 patients with HSCT were retrospectively evaluated.Results:A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62%) and allogeneic (38%) HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28%) and Hodgkin lymphoma (21.5%). A total of 142 (45%) patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011), and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2%) and Acinetobacter baumannii (8.8%) were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively.Conclusion:A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.

The growing threat of multidrug-resistant Gram-negative infections in patients with hematologic malignancies

“…Reported mortality rates after ESBL-E bacteremia in patients with hematologic malignancies range from 13%-45% (Table 2) [2,7,10-12,14-16]. The majority of studies note an increased mortality rate after ESBL-E bacteremia compared to non-ESBL-E bacteremias in this population [2,7,10,11].…”

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

“…In a report from Korea, 44% of E. coli bacteremias in HSCT recipients were ESBL producers and having an HSCT was a risk factor for ESBL‐E bacteremia . HSCT centers from Italy and Turkey reported that 18% and 23%, respectively, of E. coli bloodstream isolates and 86% and 22%, respectively, of K. pneumoniae bloodstream isolates were ESBL‐producing strains . At our own HSCT center in New York City (NYC), 29 of 89 (33%) E. coli bloodstream isolates from 2011 to 2016 had a phenotypic profile suggestive of ESBL production (ceftriaxone‐resistant, meropenem‐susceptible).…”

“…ESBLs are enzymes that are capable of hydrolyzing penicillins, monobactams, and extended‐spectrum cephalosporins . Multiple reports from oncology centers in North America, Europe, and Asia have identified ESBL prevalence rates of 17%‐37% among bloodstream isolates of Enterobacteriaceae from patients with hematologic malignancies (Table ). Not only did these reports demonstrate a high prevalence of ESBL‐E in this population, but many also reported higher mortality rates associated with ESBL‐E bacteremia compared to bacteremia caused by non‐ESBL‐producing Enterobacteriaceae.…”

Perfil Clínico De Crianças Submetidas a Transplante De Células-Tronco Hematopoiéticas

“…Observa-se, nas publicações científicas, em termos de complicações e cuidados de enfermagem no pós-TCTH, maior enfoque no período de internação (13)(14) e não no período de cuidado ambulatorial. Ressalta-se ainda lacuna nessas publicações, aborda-se usualmente crianças e adultos simultaneamente (15)(16) , com poucos estudos voltados às especificidades pediátricas.…”