Abstract
Background: Bacterial infections from multidrug resistant pathogens are an important cause of morbidity and mortality of patients undergoing hematopoietic cell transplantation (HCT). Aims: Aim of this study was to record bacteremia's from multidrug-resistant bacteria in the first hospitalized period of transplantation and their correlation with the patient's colonization. Methods: The prospective analysis includes 24 consecutive patients (14 males, 10 females), with median age of 45 years (range 24-72) who underwent HCT (21 allogeneic, 3 autologous) during 1/1/2018-15/8/2018. All patients were tested for colonization from multidrug resistant Klebsiella Pneumoniae Carbapenemase (KPC+) and Vancomycin Resistant Enterococcus (VRE+) with rectal smear and urine culture upon their hospitalization in the unit and before the start of the conditioning regimen. All patients received ciprofloxacin prophylaxis. We analyzed the bacteremia's during the first hospitalization in the Bone Marrow Transplantation Unit, approximately until day 30 after transplantation. Results: Twelve from 24 (50%) patients were found colonized with multidrug resistant pathogens upon their entry into the unit (Table 1). A total of 19 different bacteremia's occurred in 13 patients. Of the 9 non-colonized patients’ no one experienced episode of multidrug resistant KPC or VRE bacteremia. From the 6 KPC+ patients, all of them (100%) showed bacteremia, 3/6 (50%) KPC bacteremia and 3/6 bacteremia from other pathogen than KPC (Pseudomonas Aeruginosa-MBL, Staph. Epidermidis). Of the 9 VRE+ patients, 4 showed bacteremia and none (0%) showed VRE bacteremia. No mortality due to bacteremia was observed.Summary/Conclusion: There is a high rate of colonization from multi-resistant KPC and VRE in heavily treated patients referred for transplantation. Non-colonized patients did not experience KPC or VRE bacteremia, reflecting high prophylactic measures in a transplant unit. KPC colonization is associated with a remarkable (50%) probability of bacteremia from the same multidrug resistant pathogen. Our results demonstrate the importance of urine and rectal smear control for colonization with KPC in patients who are going to receive HSCT, as this can be used for targeted antibiotic treatment in case of the occurrence of febrile neutropenia
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