Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov:25 Suppl 1:e14072.
doi: 10.1111/tid.14072. Epub 2023 Jun 1.

Hematopoietic stem-cell transplantation in a zoo of multidrug-resistant organisms: Data from a cancer center in eastern India

Shouriyo Ghosh  1 , Sanjay Bhattacharya  2 , Gaurav Goel  2 , Rasika Avinash Deshmukh  2 , Rizwan Javed  1 , Mita Roychowdhury  1 , Subir Sinha  3 , Maitrayee Sarkar De  4 , Arijit Nag  1 , Jeevan Kumar  1 , Saurabh Jayant Bhave  1 , Reena Nair  1 , Mammen Chandy  1
Affiliations

Hematopoietic stem-cell transplantation in a zoo of multidrug-resistant organisms: Data from a cancer center in eastern India

Shouriyo Ghosh et al. Transpl Infect Dis. 2023 Nov.

Abstract

Background: Infections by multidrug-resistant organisms (MDRO) are a major hurdle in hematopoietic stem-cell transplants (HSCTs). Conditioning regimens lead to mucosal barrier injury, which in-turn leads to transmigration of gut bacteria and sepsis. Pre-transplant stool and throat surveillance cultures can guide empirical antibiotic policy during the neutropenic period. In this paper, we document colonization with MDRO in pre-transplant surveillance cultures and the correlation with bloodstream infections in HSCT patients and analyze transplant outcomes with respect to these infections.

Methods: A single-center, retrospective study on HSCT was performed between January 2021 and December 2021. The incidence of bacterial infections, percentage of MDROs, correlation with pre-transplant stool/throat surveillance cultures, and their impact on overall 100-day and post-100-day to 6-month post-transplant survival were analyzed.

Results: Sixty-four patients were included in the study. Pre-transplant stool surveillance cultures were positive for MDRO in 85.9% of patients. Almost half (48.5%) of the isolates were positive for carbapenemase-producing genes (mainly New Delhi metallo-beta-lactamase-1 [NDM-1] and oxacillinase-48 [OXA-48]). Eighteen patients (18/64, 28%) had a positive blood culture for MDRO in the peri-engraftment neutropenic period. Correlation between surveillance and blood cultures was seen in 61% (11/18) of patients. All-cause mortality was 14.1% (9/64) and 25% (16/64) in patients at 100 days and 6 months post-HSCT, respectively. The 100-day and post-100-day all-cause mortality rates were higher in patients with Gram-negative MDRO bloodstream infections (p < .012 and <.008, respectively).

Conclusion: MDRO infections can adversely affect HSCT outcomes. Pre-transplant stool and throat surveillance cultures may guide empirical antibiotic policy and lead to favorable transplant outcomes.

Keywords: Gram-negative sepsis; HSCT; MDRO; surveillance culture; transplant outcomes.

PubMed Disclaimer

Similar articles

See all similar articles

References

REFERENCES

    1. Torres D, Gonzalez M, Loera A, et al. The CDC definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country. Am J Infect Control. 2016;44(4):432-437.
    1. Serody J. Transplantation: bacterial sepsis and GI tract GVHD: more commensal than you think. Blood. 2012;120(1):6.
    1. Paul D, Gokarn AG, Bhat V, et al. Impact of surveillance stool culture guided selection of antibiotics in allogeneic hematopoietic stem cell transplant patients. Blood. 2016;128(22):3389. doi: 10.1182/blood.V128.22.3389.3389
    1. Korula A, Perumalla S, Devasia AJ, et al. Drug-resistant organisms are common in fecal surveillance cultures, predict bacteremia and correlate with poorer outcomes in patients undergoing allogeneic stem cell transplants. Transpl Infect Dis. 2020;22(3):e13273.
    1. Sait AS, Patole SS, Dzintars K, Cosgrove SE, Steinke SM. Rectal stool surveillance cultures to guide empiric antibiotic therapy in patients with hematologic malignancies with or without hematopoietic stem cell transplantation. Open Forum Infect Dis. 2020;7(suppl 1):S106. PMCID: PMC7777835.

MeSH terms

Substances

LinkOut - more resources