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The clinical value of anal swabs for microbial detection in allogeneic haematopoietic stem cell transplantation
Gao, J., Lin, D., Hou, C., Shen, Y., Li, Y., Wu, D., Xu, Y.
Transplantation and cellular therapy. 2023
Abstract
BACKGROUND The intestinal microbiota plays critical roles in allogeneic haematopoietic stem cell transplantation (allo-HSCT). Rapid and effective microbial detection methods have important guiding value for the selection of intervention strategies for transplant patients. We evaluate the application of anal swab test before transplantation in allo-HSCT patients. STUDY DESIGN A total of 120 allo-HSCT patients who underwent anal swab testing before allo-HSCT were retrospectively analysed and divided into sterile (aseptic growth-negative), G+ (gram-positive bacterial colonization) and G- (gram-negative bacterial colonization) groups. RESULTS 16S rRNA sequencing showed that gram-negative bacteria predominated in the G- group before and after transplantation. Compared with the sterile group, NK cell percentage was higher and T cell percentage was lower after transplantation in the G- group at one month after transplantation. The percentage of CD4+T and CD4+CD8+ T cells was lower, and the percentage of Treg was higher in the G- group. The plasma levels of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-6, and IL-17A) were lower in the G- group at 2 weeks after transplantation than in the sterile group. The cumulative incidence of grade III-IV aGVHD was lower in the G- group than in the sterile group. Gram-negative bacterial colonization before allo-HSCT was associated with low rates of BSI within 100 days posttransplatation, and CMV reactivation after 100 days to 2 years posttransplatation. Moreover, patients in the G- group had a higher rate of 2-year GRFS compared with patients in the sterile group. CONCLUSIONS The detection results using anal swabs were consistent with the gram-negative or positive bacteria abundance of 16S rRNA sequencing results and associated with immune homeostasis and clinical outcomes after allo-HSCT. Anal swab testing may have potential advantages as a simple and effective method for microbial detection in allo-HSCT.
2.
Antimicrobial resistance in Gram-negative rods causing bacteremia in hematopoietic stem cell transplant patients: intercontinental prospective study of Infectious Diseases Working Party of the European Bone Marrow Transplantation group
Averbuch, D., Tridello, G., Hoek, J., Mikulska, M., Akan, H., Yanez San Segundo, L., Pabst, T., Ozcelik, T., Klyasova, G., Donnini, I., et al
Clinical Infectious Diseases. 2017
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Abstract
Background: This intercontinental study aimed to study Gram-negative rods (GNR) resistance in hematopoietic stem cell transplantation (HSCT). Methods: GNR bacteremias occurring during six months post-HSCT (February/2014-May/2015) were prospectively collected, and analysed for rates and risk factors for resistance to fluoroquinolones, non-carbapenem anti-Pseudomonas beta-lactams (non-carbapenems), carbapenems and multidrug-resistance (MDR). Results: Sixty-five HSCT centers from 25 countries (Europe, Australia, Asia) reported data on 655 GNR episodes/704 pathogens in 591 patients (Enterobacteriaceae, 73%; non-fermentatives, 24% and 3% others). Half GNR were fluoroquinolone- and non-carbapenems-resistant; 18.5% carbapenem-resistant; 35.2% MDR. The total resistance rates were higher in allo-HSCT vs. auto-HSCT patients (p<0.001); but similar in community-acquired infections. Non-carbapenems-resistance and MDR were higher in auto-HSCT patients in centers providing vs. non-providing fluoroquinolone prophylaxis (p<0.01). Resistance rates were higher in southeast vs. north-west Europe; similar in children and adults; excluding higher fluoroquinolone- and beta-lactam beta-lactamase inhibitors-resistance rates in allo-HSCT adults. Non-Klebsiella Enterobacteriaceae were rarely carbapenem-resistant. Multivariable analysis revealed resistance risk factors in allo-HSCT patients: fluoroquinolone-resistance: adult, prolonged neutropenia, breakthrough on fluoroquinolones; non-carbapenems-resistance: hospital-acquired infection, breakthrough on non-carbapenems or other antibiotics (excluding fluoroquinolones, non-carbapenems, carbapenems), donor type; carbapenem-resistance: breakthrough on carbapenem, longer hospitalization, intensive care unit, previous other antibiotic therapy; MDR: longer hospitalization, breakthrough on beta-lactam beta-lactamase inhibitors and carbapenems. Inappropriate empirical therapy and mortality were significantly more common in infections caused by resistant bacteria. Conclusion: Our data question the recommendation for fluoroquinolone prophylaxis and call for reassessment of local empirical antibiotic protocols. Knowledge of pathogen-specific resistances enable early appropriate empirical therapy. Monitoring of resistance is crucial.