Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients

Abstract

The epidemiology of bacteremia developing during neutropenia has changed in the past decade, with the re-emergence of Gramnegative (GN) bacteria and the development of multidrug resistance (MDR) among GN bacteria. We conducted a case-control study in order to identify factors associated with bacteremia due to multidrug-resistant Gram-negative (MDRGN) isolates in hematopoietic stem cell transplant recipients. Ten patients with MDRGN bacteremia were compared with 44 patients with GN bacteremia without MDR. Bacteremia due to Burkholderia or Stenotrophomonas sp was excluded from analysis (3 cases), because the possibility of intrinsical resistance. Infection due to MDRGN bacteria occurred in 2.9% of 342 hematopoietic stem cell transplant recipients. Klebsiella pneumoniae was the most frequent MDRGN (4 isolates), followed by Pseudomonas aeruginosa (3 isolates). Among non-MDRGN, P. aeruginosa was the most frequent agent (34%), followed by Escherichia coli (30%). The development of GN bacteremia during the empirical treatment of febrile neutropenia (breakthrough bacteremia) was associated with MDR (P < 0.001, odds ratio = 32, 95% confidence interval = 5-190) by multivariate analysis. Bacteremia due to MDRGN bacteria was associated with a higher death rate by univariate analysis (40 vs 9%; P = 0.03). We were unable to identify risk factors on admission or at the time of the first fever, but the occurrence of breakthrough bacteremia was strongly associated with MDRGN bacteria. An immediate change in the antibiotic regimen in such circumstances may improve the prognosis of these patients.

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

“…11,14,16,19,27,29,35,36,39 Haematological malignancies represented the main cause of neutropenia; seven studies included also patients with solid cancer (ranging from 5% to 44% of the patient population). Acute leukaemia was the most common haematological disease in 17 (57%) studies.…”

Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation

“…12 The impact of multidrug resistant PA (MDRPA) on mortality and costs to the health service is illustrated by several studies. 7,13,14 Patients with MDRPA had significantly higher in-hospital mortality than those with more susceptible strains (67% vs. 23%; P=0.001). Reported mortality rates in adults with MDRPA range from 20% to 70%, depending on patient-and infectionrelated factors.…”

“…[1][2][3][4][5] In a European survey of intensive care units, PA was the most frequent bacterial isolate accounting for 29% of the total isolates; 6 furthermore, its multi-resistance also represents an increasing problem. [7][8] The low permeability of its cell wall, together with mutations leading to antibiotic-resistance via overexpression of efflux pumps, decreased expression of porine, or mutations in quinolone targets, 8 make PA a pathogen with high propensity to become multi-resistant to antibiotic therapy. 9 Multi-resistant strains may be responsible for nosocomial outbreaks, especially among populations at risk such as patients with cancer or cystic fibrosis.…”

Etiology, clinical features and outcomes of pre-engraftment and post-engraftment bloodstream infection in hematopoietic SCT recipients

“…Nevertheless, the differences between infections occurring pre-and post-engraftment have not been fully described. 2,6 Most published articles regarding BSI in HSCT recipients are retrospective and/or focus on subjects who underwent transplantation in the 1990 s. 3,[5][6][7][8][9][10] Since then, there have been changes in the care of HSCT recipients, such as the introduction of different types of donors, different immunosuppression, conditioning chemotherapy including reduced-intensity regimens, and so on. Furthermore, changes in the etiology of BSI in cancer patients have recently been described.…”

“…12 However, current and prospective information regarding the etiology and antimicrobial resistance of BSI in the specific group of patients undergoing HSCT is scarce. 1,4,8,13 The present study was performed to determine the etiology, current clinical features and outcomes of BSI in a more recent prospective cohort of adult HSCT recipients, and to identify differences between those episodes occurring in the pre-engraftment and postengraftment periods. A better understanding of these characteristics may help to optimize the management of patients in the transplant setting.…”