Weekly Screening for Multidrug-Resistant Organisms Identifies High Number of Colonizations in Patients Undergoing Stem Cell Transplantation
Authors: Monsalvo Silvia , Balsalobre Pascual , Dorado Herrero Nieves , Solán Laura , Fernandez-Cruz Ana , Machado Marina , Vigil-Escribano Maria Dolores , Anguita Javier , Díez-Martín Jose Luis , Kwon Mi 
Published: October 2019

Introduction:

Multidrug-resistant organisms (MDRO) are a challenge in patients undergoing stem cell transplant (SCT) which often result in an increase in mortality. To our knowledge, current literature defines only screening at the time of work-up for SCT-patients. The aims of the study were to assess the rate of MDRO colonization with weekly screening, rate of infection and the associated mortality in patients undergoing SCT.

Patients and methods:

Consecutive patients admitted at the SCT unit between January-18 to July-18 were reviewed in our institution. Screening consisted of rectal and perineal swab on admission and weekly until the date of discharge. In case of detection of MDRO , patients were isolated and infection control strategies were applied.

Results:

41 patients were analysed, with 47 admissions, 6 patients had 2 admissions. The median duration of hospitalization was 27 days/patient (range 8-100). 168 rectal-and perineal swab were performed with a median of 3 swabs/patient (range 1-7). Patient characteristics are shown in Table 1. 36 patients (87%) spiked fever in a median of 8,5 days after admission (1-38days). 24,4% (n=10) had a positive screening: 2/10 patients at baseline and 8/10 patients (80%) were detected for the first time beyond baseline screen. Rate of MDRO colonization was 3% per week (95%CI 1.4-5.4). MDRO identified were : 4 patients with Extended-spectrum beta-lactamases producing E. Coli (ESBL-EC), Multidrug-resistant (MR) Pseudomonas aeruginosa (n=3), Vancomycin-resistant Enterococci (n=2) and 1 patient with carbapenem-resistant Citrobacter freundii. 6/10 patients developed MDRO infection (60%), all with previous MDRO positive detection: MR-Pseudomonas aeruginosa in urine culture (n=3) 2 treated with ceftolozane/tazobactam, 1 with meropenem+amikacin; ESBL-EC in urine culture (n=2) both treated with meropenem and 1 with Klebsiella pneumoniae carbapenemase in urine culture treated with ceftazidime/avibactam. The infection rate was 4,6% (95% CI 3.9-5.2). In 80% patients (n=8) antibiotic treatment was guided by positive screening, 3 patients were admitted to intensive care unit for sepsis. No mortality was associated to MDRO.

In 76%of patients (n=28) screening was negative for MDRO. 24/28 (85%) spiked fever with a median of 10 days after admission (1-38days). None MDRO-infections in negative-screened patients were detected.

Conclusions :

Weekly screening for MDRO identified a high number of MDRO colonizations allowing to apply early strategies of infection control in high risk patients . Besides, MDRO infection occurred only in patients previously colonized, therefore, 80% of our cohort could benefit from guided treatment by the time of the febrile episode. Early identification of MDRO colonization might have helped to reduce MDRO related mortality. However, these findings should be confirmed with further studies, comparing baseline with weekly MDRO screening strategies.

Disclosures

No relevant conflicts of interest to declare.