Colonization by multidrug-resistant bacteria in hematological patients undergoing hematopoietic stem cell transplantation and clinical outcomes: A single-center retrospective cohort study

被引:2
作者
Santos, Eduardo Sbrana [1 ]
Lima, Alberto Cardoso Martins [1 ]
Breda, Giovanni Luis [2 ]
Tomaz, Ana Paula de Oliveira [1 ]
Nabhan, Samir Kanaan [3 ]
Funke, Vaneuza Araujo Moreira [3 ]
Loth, Gisele [3 ]
Nogueira, Keite da Silva [1 ,4 ]
机构
[1] Univ Fed Parana, Complexo Hosp Clin, Clin Anal & Pathol Anat Unit, Curitiba, Brazil
[2] Univ Fed Parana, Complexo Hosp Clin, Infect Dis Div, Curitiba, Brazil
[3] Univ Fed Parana, Complexo Hosp Clin, Bone Marrow Transplantat Unit, Curitiba, Brazil
[4] Univ Fed Parana, Complexo Hosp Clin, Clin Anal & Pathol Anat Unit, Bacteriol Lab, Padre Camargo St 280, BR-80060240 Curitiba, Parana, Brazil
关键词
bacterial colonization; bloodstream infections; hematological diseases; hematopoietic stem cell transplantation; multidrug resistance; TOTAL-BODY IRRADIATION; VERSUS-HOST-DISEASE; CONSENSUS DEVELOPMENT PROJECT; BLOOD-STREAM INFECTION; KLEBSIELLA-PNEUMONIAE; INJURY; ENTEROBACTERIACEAE; ORGANISMS; MORTALITY; DIAGNOSIS;
D O I
10.1111/tid.14119
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Bloodstream infections are a leading cause of death in patients who undergo hematopoietic stem cell transplantation (HSCT) and are more severe when caused by multidrug-resistant (MDR) bacteria. This study proposed to investigate if colonization by MDR bacteria negatively affects the clinical outcomes in hematological patients after HSCT, as well as to evaluate possible risk factors for death due to bacteremia by the same colonizing agent. Methods: A single-center retrospective cohort study was conducted with 405 hematological patients submitted to a single HSCT procedure between 2015 and 2021. Patients were classified as colonized (n = 132) or noncolonized (n = 273) based on the surveillance cultures from D-30 to D+30 of transplantation, and their relevant clinical and laboratory data were collected until D+100. Results: Colonization by MDR bacteria increased blood culture positivity by all microorganisms and also specifically by MDR bacteria, with a more pronounced effect when caused by carbapenemase-producing Klebsiella pneumoniae. Patients colonized with carbapenem-resistant K. pneumoniae had increased overall mortality (HR = 4.07, 95% CI 1.85-8.91, P = .0005) and had prolonged hospital length of stay in the context of autologous transplantation. Risk factors for death due to bacteremia by the same colonizing agent were neutropenia, colonization by carbapenem-resistant K. pneumoniae and use of high-dose total body irradiation in conditioning. Conclusion: Hematological patients colonized by MDR bacteria presented a higher incidence of bloodstream infections, and colonization by carbapenemase-producing K. pneumoniae was associated with reduced overall survival.
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页数:12
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