The role of colonization with resistant Gram-negative bacteria in the treatment of febrile neutropenia after stem cell transplantation
Language English Country England, Great Britain Media print-electronic
Document type Journal Article
PubMed
39277087
DOI
10.1016/j.jhin.2024.08.012
PII: S0195-6701(24)00294-9
Knihovny.cz E-resources
- Keywords
- ESBL positive, Febrile neutropenia, Multidrug resistant, Stem cell transplantation,
- MeSH
- Anti-Bacterial Agents * therapeutic use MeSH
- Adult MeSH
- Febrile Neutropenia * microbiology MeSH
- Gram-Negative Bacterial Infections * drug therapy epidemiology MeSH
- Gram-Negative Bacteria * drug effects isolation & purification MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Drug Resistance, Multiple, Bacterial MeSH
- Carrier State microbiology epidemiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Sepsis microbiology MeSH
- Hematopoietic Stem Cell Transplantation adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- Anti-Bacterial Agents * MeSH
BACKGROUND: Febrile neutropenia (FN) is a common complication of stem cell transplantation. AIM: To evaluate the frequency of sepsis in patients with FN colonized with resistant Gram-negative bacteria (extended-spectrum β-lactamase (ESBL)-positive, multidrug-resistant (MDR) Pseudomonas aeruginosa) and the choice of primary antibiotic in colonized patients. METHODS: This retrospective study analysed data from patients undergoing haematopoietic stem cell transplantation from January 2018 to September 2022. Data were extracted from the hospital information system. FINDINGS: Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/-AmpC patients, 31.5% of ESBL+ patients, and 0% of MDR P. aeruginosa patients. Patients with FN and MDR P. aeruginosa colonization had a high prevalence of sepsis (namely 100%, P = 0.0197). The spectrum of sepsis appeared to be different, with Gram-negative bacilli predominating in the ESBL+ group (OR: 5.39; 95% CI: 1.55-18.76; P = 0.0123). Colonizer sepsis was present in 100% of sepsis with MDR P. aeruginosa colonization (P = 0.002), all in allogeneic transplantation (P = 0.0003), with a mortality rate of 33.3% (P = 0.0384). The incidence of sepsis in patients with ESBL+ colonization was 25.9% (P = 0.0197), with colonizer sepsis in 50% of sepsis cases (P = 0.0002), most in allogeneic transplantation (P = 0.0003). CONCLUSION: The results show a significant risk of sepsis in FN with MDR P. aeruginosa colonization, a condition almost exclusively caused by the colonizer. At the same time, a higher risk of Gram-negative sepsis has been demonstrated in patients colonized with ESBL+ bacteria.
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