scholarly journals Usefulness of surveillance Cultures for Carbapenem-resistant Enterobacteriaceae, Carbapenem-resistant Pseudomonas aeruginosa and Vancomycin-resistant Enterococci in Hematopoietic Stem Cell Transplant Unit

2020 ◽  
Author(s):  
Elisa Teixeira Mendes ◽  
Matias Chiarastelli Salomão ◽  
Lísia Moura Tomichi ◽  
Maura Salaroli Oliveira ◽  
Mariana Graça ◽  
...  
Keyword(s):  
Blood Stream Infection ◽  
Blood Stream ◽  
Cell Transplant ◽  
Surveillance Culture ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Surveillance Cultures ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Surveillance strategies to detect colonization is an important tool to prevent and control the spread of microorganisms especially among Hematopoietic Stem Cell Transplant (HSCT) patients. Colonization by Multidrug-resistant organisms (MDRO) has been evaluated as a risk factor for blood stream infection (BSI) in HSCT patients. The aim of this study was to evaluate the use of routine surveillance culture to screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa) and vancomycin-resistant enterococci (VRE) in a HSCT unit. Methods Surveillance cultures were collected from patients admitted to the HSCT unit over one-year, with swabs for cultures on admission and then weekly until discharge. We compared surveillance culture positivity for each site and agent, also clinical and epidemiological data according to the colonization status. Results 200 HSCT patients underwent surveillance, with 1.323 samples collected. Infection due to MDRO occurred in 52 (21.5%) patients, among them 45 (86.5%) were blood stream infection (BSI) and 12 (23%) had positive surveillance culture before infection. 554 (41.8%) surveillance cultures were performed for CRPa, 413 (31.2%) for VRE, and 356 (27%) for CRE. Of these, 179 (13.5%) surveillance culture were positive, with greater positivity for oropharynx (6, 35.3%) CRPa, and rectal samples (16, 20.7%) for CRE. Being colonized by any MDRO, CRE (p <0.001) and CRPa (p = 0.027) was associated with a higher risk of infection in the bivariate analysis but being colonized was not associated with risk of death. Conclusion Previous colonization by MDRO was a significant risk factor for infection by these pathogens, mainly colonization by CRE. Overall, rectal swab was the best site with the higher positivity, and the oropharynx was also an option for CRPa investigation. Feces culture showed low positivity and should be avoided. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, VRE surveillance should be questioned in auto-HSCT patients as it has an additional cost and little impact on survival.

scholarly journals 737. Novel Glycans Reduce Carbapenem-Resistant Enterobacteriaceae and Vancomycin-Resistant Enterococci Colonization in an Ex Vivo Assay by Supporting Growth and Diversity of Commensal Microbiota at the Expense of MultiDrug-Resistant Organisms (MDRO)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S330-S330
Author(s):  
Gabby LeBlanc ◽  
Brandon Brooks ◽  
Madeline Hartman ◽  
Maxwell B Hecht ◽  
Hoa Luong ◽  
...  
Keyword(s):  
Critically Ill ◽  
Ex Vivo ◽  
Metagenomic Sequencing ◽  
Clinical Infection ◽  
Commensal Microbiota ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Infections with Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococci (VRE) can result in a 50% mortality rate in compromised hosts. A major risk factor for clinical infection is intestinal colonization with CRE or VRE. There are currently no FDA-approved compounds to decolonize these organisms from the gastrointestinal tract (gut). Commensal microbes offer protection from pathogen infection; however, in immunocompromised hosts or with antibiotic treatment, the protective properties of the microbial community are compromised, leaving the gut susceptible to pathogen colonization. Higher concentrations of pathogens within the gut correlate with an increased risk of infection with MDROs. Our hypothesis is that reducing colonization of the gut with MDROs would reduce the likelihood of a clinical infection. Methods Kaleido built a platform that emulates the gut environment and allows for high throughput screening of Kaleido’s Microbiome Metabolic Therapies (MMT™) in human gut microbiomes ex vivo. Over 500 compounds were screened for their ability to reduce the levels of CRE and VRE in fecal microbial communities from both healthy subjects and critically ill patients receiving broad-spectrum antibiotics. Results Kaleido’s lead MMTs selectively favor the growth of the commensal microbiota at the expense of pathogens, resulting in a decrease of CRE and VRE from 80% of the initial community to 5% in a single batch culture, as measured by 16S rRNA gene and shotgun metagenomic sequencing. Lead MMTs do not support growth of CRE and VRE strains in culture, nor of other pathogens frequently encountered in critically ill and immunocompromised patients, such as Clostridium difficile and common fungal pathogens. Conclusion These results suggest that intervention with MMTs may reduce CRE and VRE colonization and support further evaluation in patients colonized with CRE or VRE pathogens. Disclosures All authors: No reported disclosures.

scholarly journals Tandem fecal microbiota transplantation cycles in an allogeneic hematopoietic stem cell transplant recipient targeting carbapenem-resistant Enterobacteriaceae colonization: a case report and literature review

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Fengqin Su ◽  
Yi Luo ◽  
Jian Yu ◽  
Jimin Shi ◽  
Yanmin Zhao ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Fecal Microbiota Transplantation ◽  
Fecal Microbiota ◽  
Stool Culture ◽  
Resistant Bacteria ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Due to limited antibiotic options, carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high non-relapse mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Also, intestinal CRE colonization is a risk factor for subsequent CRE infection. Several clinical studies have reported successful fecal microbiota transplantation (FMT) for the gut decontamination of a variety of multidrug-resistant bacteria (MDRB), even in immunosuppressed patients. Similarly, other studies have also indicated that multiple FMTs may increase or lead to successful therapeutic outcomes. Case presentation We report CRE colonization in an allo-HSCT patient with recurrent CRE infections, and its successful eradication using tandem FMT cycles at 488 days after allo-HSCT. We also performed a comprehensive microbiota analysis. No acute or delayed adverse events (AEs) were observed. The patient remained clinically stable with CRE-negative stool culture at 26-month follow-up. Our analyses also showed some gut microbiota reconstruction. We also reviewed the current literature on decolonization strategies for CRE. Conclusions CRE colonization led to a high no-relapse mortality after allo-HSCT; however, well-established decolonization strategies are currently lacking. The successful decolonization of this patient suggests that multiple FMT cycles may be potential options for CRE decolonization.

Secular Trends of Blood Stream Infections in the 72 Hours Prior to Death in Allogeneic Hematopoietic Cell Transplant Recipients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3891-3891
Author(s):  
Shylaja Mani ◽  
Lisa A. Rybicki ◽  
Navneet S. Majhail ◽  
Sherif Mossad
Keyword(s):  
Bacterial Infections ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Gram Negative ◽  
E Coli ◽  
Vancomycin Resistant ◽  
Over Time

Abstract Blood stream infections (BSI) are a common cause of morbidity and mortality in hematopoietic cell transplant (HCT) recipients especially in the first year post transplant. With emergence of multi- drug resistant (MDR) organisms, especially enterobacteriaceae and enterococci, early treatment with targeted antibiotics remains challenging. Despite antimicrobial prophylaxis and initiation of empiric broad spectrum antimicrobials early in the course of treatment, BSI is an independent predictor of mortality after HCT, with mortality rates after BSI as high as 27% in the first 30 days following HCT. The characteristics of specific organisms identified shortly before death have not been well described. This information may guide empiric antimicrobial treatment and eventually primary prevention of these infections. We conducted a retrospective single center study of 529 patients who received an allogeneic HCT and died between 2000- 2013. Among these patients, 216 had a clinical indication for a blood culture within 72 hours prior to death and we investigated secular trends in BSI (microbiological spectrum and antimicrobial susceptibility pattern) for all pathogens in this population. Overall, 104 BSI were identified from 91 patients. Blood stream infection and criteria for drug resistance in different organisms were defined according to the CDC and National Healthcare Safety Network surveillance definitions. Bacterial infections were the most common comprising of 87% of 104 BSI. Gram positive bacteria accounted for 50% and gram negative bacteria for 37% of infections. Amongst these, enterococcus (30%), staphylococcus (16%), pseudomonas (16%), klebsiella (5%) and E. coli (4%) were the most commonly identified organisms. Most of the enterococci were vancomycin resistant (VRE 87%), all staphylococci—both coagulase negative and S. aureus—were methicillin resistant, 64% of pseudomonas were multidrug resistant and all Klebsiella and E. Coli isolates were either extended spectrum Beta lactamase producers or carbapenem resistant. Over time there was a significant increase in VRE (7.7/100 deaths in 2000 to 12.5/100 deaths in 2013, p=0.017) and gram negative bacterial infections (7.7 in 2000 to 12.5 in 2013, p=0.011), particularly Klebsiella, E. coli and Stenotrophomonas infections. Interestingly there was a decrease in staphylococcal (15.4 in 2000 to 0 in 2013, p=0.041) and streptococcal (p=0.06) infections. Fungal infections comprised of 12% of all BSI, with Candida being the most common organism identified (50%), but there was no significant change in trend over time. Blood stream infection was either the primary or secondary cause of death in 53% of patients who had a positive culture. In conclusion, Vancomycin resistant enterococcal infections are the most common BSI identified 72 hours prior to death in allogeneic transplant recipients; prompting us to consider appropriate antibiotic coverage even empirically in critically ill HSCT recipients. With the increase in MDR pseudomonas and resistant E. coli and Klebsiella, we might need to consider appropriate empiric gram negative coverage, and escalating antibiotics earlier if there is no response clinically. With the proper central/peripheral intravenous catheter care, we have seen a decrease in staphylococcal BSI over time, reinforcing primary prevention of BSI. Disclosures No relevant conflicts of interest to declare.

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