Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation

Luo

Antimicrob Resist Infect Control

et al. 2020

Background: A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). Methods:We retrospectively studied the clinical data of 395 consecutive HSCT patients from (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. Results: During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P < 0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 h of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 h after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 h after fever onset and died of septic shock. Conclusion:The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

Luo

Antimicrob Resist Infect Control

et al. 2020

“…Among the 209 remaining articles, 132 studies provided unclear antibiotic treatment, 17 included patients less than 10 people, 14 did not report clinical outcomes of interest, 12 treated all patients with monotherapy and/or double therapy, and 1 used duplicated data. Hence, a total of 33 eligible studies were included in this current meta-analysis (Souli et al, 2008;Maltezou et al, 2009;Zarkotou et al, 2011;Qureshi et al, 2012;Sanchez-Romero et al, 2012;Navarro-San Francisco et al, 2013;Balandin Moreno et al, 2014;Balkan et al, 2014;Daikos et al, 2014;Kontopidou et al, 2014;Papadimitriou-Olivgeris et al, 2014;Pontikis et al, 2014;Chang et al, 2015;de Oliveira et al, 2015;Freire et al, 2015;Ji et al, 2015;Katsiari et al, 2015;Oliveros Navarro et al, 2015;Tumbarello et al, 2015;Falcone et al, 2016;Satlin et al, 2016;Shields et al, 2016;Trecarichi et al, 2016;de Maio Carrillho et al, 2017;Forcina et al, 2017;Kaur et al, 2017;Liao et al, 2017;Machuca et al, 2017;Wang et al, 2018;Yang et al, 2018;Freire et al, 2019;Medeiros et al, 2019;Xu et al, 2019).…”

Section: Description Of the Search And Selection Of Trialsmentioning

confidence: 99%

Triple Versus Double Therapy for the Treatment of Severe Infections Caused by Carbapenem-Resistant Enterobacteriaceae: A Systematic Review and Meta-Analysis

et al. 2020

Introduction: The role of combination treatment in the management of carbapenemresistant Enterobacteriaceae infections (CRE) is still unclear. There have been no metaanalysis comparing the efficiency of triple therapy in treating CRE infections with that of double therapy. In this perspective, we conducted a meta-analysis to clarify whether triple therapy is superior to double therapy in treating patients with CRE infections. Methods:We performed a systematic review, using PubMed and Embase without any restrictions until October 2019. Risk ratio (RR) with 95% CI were pooled to evaluate the effect of intervention.Results: A total of 33 studies with 1,441 subjects were identified. Pooled analysis showed that triple therapy was not associated with a reduced mortality compared with double therapy (HR 0.99 95% CI 0.85-1.14, P = 0.85). Conclusions:This meta-analysis suggests that triple therapy is not superior to double therapy in the treatment of patients with CRE infections, although the quality of evidence is generally low based on current literatures. Future well-defined, randomized controlled trials will be required to elucidate the role of triple therapy in the treatment of CRE infections.

“…A recent national multicenter study from 25 provinces in China reported that the rate of carbapenem resistance in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) was up to 0.6-3.6% and 1.2-18.9%, with 1.8% and 12.3% in Zhejiang Province, respectively, which has increased year after year [2]. Long-term hospitalization, frequent use of broad-spectrum antibiotics, high-dose chemotherapy, neutropenia, compromised immunity, and gastrointestinal mucosal destruction are risk factors favoring CRE colonization and bloodstream infections (BSIs) in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) [3][4][5][6][7][8]. The overall incidence of BSIs caused by CRE in HSCT recipients is approximately 1.8-2%.…”

Section: Introductionmentioning

confidence: 99%

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

et al. 2020

Preprint

Background A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). Methods We retrospectively studied the clinical data of 395 consecutive HSCT patients from September 2017 to April 2019. From September 2017 to June 2018 (period 1), 200 patients received single CRE screening before transplantation. From July 2018 to April 2019 (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. Results During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P<0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 hours of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 hours after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 hours after fever onset and died of septic shock. Conclusion The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.