Abstract
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for selected diseases of the hematopoietic system. In the context of HSCT, bloodstream infections caused by Gram-negative bacteria (GNB) significantly contribute to morbidity and mortality. Antibiotic treatment of bloodstream infections with carbapenem-resistant (CR) GNB presents a particular challenge. As a part of our infection control management, the admission of a patient who was known to be colonized with a CR Acinetobacter baumannii triggered an active weekly screening of all patients to determine the prevalence and potential transmission of CR GNB and CR Acinetobacter baumannii in particular. Over a 3 month period a total of 71 patients were regularly screened for colonization with CR GNB. Including the index patient, a total of three patients showed CR GNB colonization representing a prevalence of 4.2%. Nosocomial transmission of CR Acinetobacter baumannii or other CR GNB was not observed. However, the index patient developed a subsequent bloodstream infection with the CR Acinetobacter baumannii, therefore empiric antibiotic therapy based on the known resistance profile was initiated. A weekly prevalence screening for CR GNB might be an effective monitoring tool for potential transmission, may enhance existing infection control management concepts and may support the decision making for empiric antibiotic therapy.
Highlights
Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for nosocomial infections
As a part of our infection control management, we closely monitored the prevalence of CR Gram-negative bacteria (GNB) on our HSCT unit, while an index patient with a CR Acinetobacter baumannii was treated on the ward
The patient with the CR Acinetobacter baumannii colonization developed subsequently a Bloodstream infection (BSI) with this Acinetobacter, whereas the other two patients did not develop an invasive infection with their CR GNB
Summary
Patients undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for nosocomial infections. One possible mechanism is that conditioning regimens induce leaky gut syndrome and promote translocation of Gram-negative bacteria (GNB) from the gut and cause bloodstream infections (BSIs) [1]. The antibiotic therapy in those patients has recently become more difficult since the emergence of carbapenem-resistant (CR) GNB [2]. In hematopoietic stem cell recipients and neutropenic patients an increased mortality has been shown in case of a BSI caused by CR GNB [4, 5]. As a part of our infection control management, we closely monitored the prevalence of CR GNB on our HSCT unit, while an index patient with a CR Acinetobacter baumannii was treated on the ward. Within this report we discuss the implications of CR GNB for infection control and guidance of empiric antibiotic therapy
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