Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units

Surveillance strategies to detect colonization are an important tool to prevent and control the spread of microorganisms in hematopoietic stem cell transplant (HSCT) units. The aim of this study was to evaluate routine surveillance cultures for screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa), and vancomycin-resistant enterococci (VRE). Surveillance cultures were collected (1,323 samples) from 200 patients admitted to an HSCT unit over one year; swabs were taken on admission and then weekly. We compared the positivity of cultures for each site, agent, clinical and epidemiological data according to the colonization status. Infection due to multidrug-resistant organisms (MDROs) occurred in 52 (21.5%) patients, 45 (86.5%) due to blood stream infection; 12 (23%) patients had a positive surveillance culture before the infection. Cultures of 554 (41.8%) samples were performed for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 (13.5%) were positive. Colonization by any MDRO, CRE or CRPa was associated with increased risk of infection (P < 0.05), but not with death. Previous colonization by an MDRO was a significant risk for infection by these pathogens, specially by CRE. Overall, rectal swabs had the highest positivity rate compared with other sites, oropharynx swabs were an option for CRPa, and fecal cultures showed low positivity. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, routine VRE surveillance should be questioned with regard to patients undergoing auto-HSCT due to the additional cost and little impact on survival rates.

Palavras-chave

Hematopoietic stem cell transplant infection, Hospital-acquired infection, Multidrug-resistant organisms, Surveillance cultures, Blood stream infection

URI

https://observatorio.fm.usp.br/handle/OPI/43751

Referências

Aschbacher R, 2020, ANTIMICROB RESIST IN, V9, DOI 10.1186/s13756-020-00771-0
Averbuch D, 2017, CLIN INFECT DIS, V65, P1819, DOI 10.1093/cid/cix646
Baier C, 2019, ANTIMICROB RESIST IN, V8, DOI 10.1186/s13756-019-0606-3
Bilinski J, 2016, BIOL BLOOD MARROW TR, V22, P1087, DOI 10.1016/j.bbmt.2016.02.009
do Prado GVB, 2016, J GLOB ANTIMICROB RE, V6, P27, DOI 10.1016/j.jgar.2016.02.002
Bouza E, 2011, CURR OPIN INFECT DIS, V24, P302, DOI 10.1097/QCO.0b013e328348b1b9
Demiraslan H, 2017, AM J INFECT CONTROL, V45, P735, DOI 10.1016/j.ajic.2017.01.006
Ferreira AM, 2018, J HOSP INFECT, V100, P83, DOI 10.1016/j.jhin.2018.03.004
Forcina A, 2018, BIOL BLOOD MARROW TR, V24, P1476, DOI 10.1016/j.bbmt.2018.02.021
Hefazi M, 2016, TRANSPL INFECT DIS, V18, P913, DOI 10.1111/tid.12612
Heidenreich D, 2018, ANN HEMATOL, V97, P2501, DOI 10.1007/s00277-018-3475-6
Korula A, 2020, TRANSPL INFECT DIS, V22, DOI 10.1111/tid.13273
Lisboa LF, 2015, INT J INFECT DIS, V33, P171, DOI 10.1016/j.ijid.2015.02.001
Nesher L, 2015, TRANSPL INFECT DIS, V17, P33, DOI 10.1111/tid.12323
Patriarca F, 2017, BIOL BLOOD MARROW TR, V23, P333, DOI 10.1016/j.bbmt.2016.11.005
Sadowska-Klasa A, 2018, ANN HEMATOL, V97, P509, DOI 10.1007/s00277-017-3205-5
Scheich S, 2017, BIOL BLOOD MARROW TR, V23, P1455, DOI 10.1016/j.bbmt.2017.05.016
Tacconelli E, 2019, CLIN MICROBIOL INFEC, V25, P807, DOI 10.1016/j.cmi.2019.01.005
Tomblyn M, 2009, BIOL BLOOD MARROW TR, V15, P1143, DOI 10.1016/j.bbmt.2009.06.019
Yan L, 2020, ANTIMICROB RESIST IN, V9, DOI 10.1186/s13756-020-00816-4
You JHS, 2018, AM J INFECT CONTROL, V46, P291, DOI 10.1016/j.ajic.2017.09.003

Coleções

Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/03
Artigos e Materiais de Revistas Científicas - LIM/31
Artigos e Materiais de Revistas Científicas - LIM/49

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