Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center

Ghafur, Abdul; Devarajan, Vidya; Raj, Revathi; Easow, Jose; Raja, T

doi:10.4103/0019-509x.204766

Cited by 6 publications

(4 citation statements)

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“…The treatment of fungal infections, which were once a frequent cause of peri‐transplant mortality has seen significant gains in terms of antifungal prophylaxis, adjunctive tests to initiate early therapy in fungal infection, and an increasing arsenal of antifungals . On the other hand, multidrug‐resistant (MDR) bacterial infections have been increasingly implicated in post‐transplant infection‐related mortality with traditionally recommended antibacterial prophylaxis proving ineffective in reducing mortality in the current clinical setting …”

Section: Introductionmentioning

confidence: 99%

“…Carbapenem‐resistant Klebsiellapneumoniae infections occur in 1%‐18% of solid organ transplant patients, and patients with hematological malignancies represent 16%‐24% of all patients with carbapenem‐resistant Enterobacteriaceae . In the setting of emerging pathogens showing multidrug resistance and the high mortality associated with these infections in the transplant setting, we sought to study the prevalence and pattern of E coli, Klebsiella spp. , and Enterococcus spp.…”

Section: Introductionmentioning

confidence: 99%

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Drug‐resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants

Korula

Perumalla

Devasia

et al. 2020

Transplant Infectious Dis

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Background:With the increasing incidence of multidrug-resistant (MDR) organisms and high mortality rates associated with these infections, we describe the spectrum of the major drug-resistant pathogens identified in fecal surveillance, and re-visit the use of fecal surveillance in predicting infection with these organisms post-allogeneic stem cell transplant. Methods: Data from allogeneic stem cell transplant recipients with common drugresistant strains of bacteria in fecal surveillance (Escherichia coli, Klebsiella spp., and Enterococcus spp.) were compared with recipients who did not have the same in fecal surveillance cultures. Baseline characteristics and post-transplant outcomes including similar drug resistance in blood cultures, severe sepsis, and 100-day transplantrelated mortality were compared. Multivariate analysis using logistic regression model was used to determine independent predictors of outcome.Results: In 232 transplants, the prevalence of common drug-resistant isolates in fecal surveillance cultures was 57.7% (134 out of 232 patients-with a single isolate in 115 and ≥2 isolates in the remaining 19 patients. A total of 164 drug-resistant isolates were obtained from 134 patients. Of the 164 isolates, 133 (81%) were positive for ESBL screening, 19 (11.5%) for carbapenem-resistant organisms (CRO) screening, 12 (7.3%) for VRE screening. Patients who had common drug-resistant pathogens detected in fecal surveillance have significantly higher subsequent blood culture positivity with drug resistance, as well as higher 100-day mortality. Factors influencing 100-day mortality included patient's age (P = .001), drug resistance positivity in blood (P < .001), drug resistance in fecal surveillance (P = .011), use of an alternate donor (other than fully matched sibling) (P < .001), GVHD grade 3-4 (P < .001), and severe sepsis (P < .001). On multivariate analysis, only use of an alternate donor (0.024), severe sepsis (P < .001), and grade 3-4 GVHD (P < .001) retained significance in predicting 100-day mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drug‐resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants

Korula

Perumalla

Devasia

et al. 2020

Transplant Infectious Dis

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“… 8,17–24 However, gram‐negative organisms were commonly isolated in our series. Of the 12 gram‐negative organisms, 6 were multi‐drug resistant organisms 26–28 . Data from other transplant centres in India shows predominant gram‐negative infections in post‐transplant setting.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Impact of microbial contamination of haematopoietic stem cells on post‐transplant outcomes: A retrospective study from tertiary care centre in India

Garg

Kodan

Pushpam

et al. 2021

Transfusion Medicine

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Background Haematopoietic stem cells (HSC) may act as a source of infection for the recipient due to manipulation at multiple levels from collection to infusion. Due to the high risk of contamination cultures are usually taken during multiple steps. The clinical significance of microbial contamination of HSC on the post‐transplant course and the role of prophylactic antibiotics is relatively unknown. Aims and methods The aim of our study is to investigate the incidence of microbial contamination of haematopoietic stem cell and to assess its impact on the post‐transplant febrile neutropenia, engraftment kinetics, hospitalisation and day 100 mortality. Details of all patients admitted in the bone marrow transplantation unit of a tertiary care centre in India between January 2014 and December 2018 were collected from case records. Results Of the 1306 stem cell harvests from 503 patients sent for culture, 17 harvests (1.3%) were found to have a culture positive report. Sixteen patients had undergone autologous transplant. Multiple myeloma was most common indication of HSC transplant followed by Non‐Hodgkin Lymphoma (NHL). Twelve of 17 HSC cultures were positive at the time of infusion and five were positive at the time of harvest. The five HSC that were culture positive at the time of harvest were culture negative at the time of infusion. Gram‐positive organisms were isolated in six cultures and gram‐negative in rest. All patients developed febrile neutropenia post‐transplantation between day 1 and day 7. The median time of onset of fever was day +5 (1–7), the median duration of fever was 4 days (2–7), the median duration of antibiotic use was 11 days (9–16). Median day for neutrophil engraftment was 11 days (9–16), the median day for platelet engraftment was 14 days (10–25) and median duration of hospitalisation was 15 days (12–78). All patients were alive at day 100 of transplant. Conclusion This study shows that there appears to be minimal impact of culture positive HSC on transplant related outcomes in terms of engraftment kinetics, duration of hospitalisation and day 100 mortality. Discarding of contaminated HSC may not be required, though on development of febrile neutropenia appropriate antibiotics should be administered based on sensitivity pattern of HSC culture. Larger prospective studies are needed to determine the clinical relevance of such contaminations. Emphasis should be laid on better infection control practices to minimise contamination rates.

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“…Bacteremic infections in the post-hematopoietic stem cell transplantation setting are predominantly due to Gram-negative organisms in the Indian context. 1 Aeromonas bacteremia in patients with malignancy is associated with a higher mortality rate than bacteremia caused by other organisms. 2 Aeromonas sobria has been reported to cause fulminant necrotizing fasciitis in patients with neutropenia 2 in only a few pieces of literature.…”

Section: Introductionmentioning

confidence: 99%

A Case of Severe Aeromonas Bacteremia with Necrotizing Fasciitis of Lower Limb and Fournier's Gangrene in a Post-Allogenic Unrelated Hematopoietic Stem Cell Transplant Recipient

Das

Ghafur

Jeyasankar

et al. 2022

South Asian J Cancer

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Background Aeromonas is a water-dwelling Gram-negative bacillus primarily associated with gastrointestinal tract diseases. Aeromonas sobria causing gastroenteritis has been reported in India. In immunocompromised host, Aeromonas sobria can also present with severe necrotizing skin and soft tissue infection with a high mortality rate. We report a case of Aeromonas sobria sepsis with skin and soft tissue infection in the background of immunosuppression. Case Presentation Fifty-year-old male who underwent an unrelated donor peripheral stem cell transplant for relapsed pre-B acute lymphoblastic leukemia in complete clinical remission on graft versus host disease prophylaxis, post-white blood cell engraftment presented with acute onset lethargy, lower limb pain without fever, or any skin changes initially. He rapidly worsened clinically over few days and developed sepsis, multiorgan dysfunction with the appearance of erythema and blister over the lower limb, and Fournier's gangrene of scrotum. He was found to have Aeromonas sobria bacteremia with isolated resistance to carbapenems while sensitive to all other classes of antibiotics. Despite appropriate antibiotic therapy and supportive measures, he succumbed to death for this invasive bacterial disease. Conclusion Aeromonas should be considered a cause of sepsis in immunosuppressed hosts, especially those with hematological malignancy presenting with necrotizing skin and soft tissue infection. Considering the virulence of this pathogen, despite the very susceptible antibiogram, such patients must be managed aggressively. Early recognition of the disease with a combination of medical and surgical management might help to improve the outcome.

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Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center

Abstract: Glycopeptides need not be included in the empirical antibiotic regimen in post-HSCT settings with very low Gram-positive infection rates.

Cited by 6 publications

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Drug‐resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants

Drug‐resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants

Impact of microbial contamination of haematopoietic stem cells on post‐transplant outcomes: A retrospective study from tertiary care centre in India

A Case of Severe Aeromonas Bacteremia with Necrotizing Fasciitis of Lower Limb and Fournier's Gangrene in a Post-Allogenic Unrelated Hematopoietic Stem Cell Transplant Recipient

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