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Multidrug Resistant Bacteremia: Clinical And Bacteriological Epidemiology In Hematopoietic Stem Cell Transplant Recipients

Mellouli A

Background: Bacteremia becomes increasingly fearsome in hematopoietic stem cell transplant (HSCT) recipients with the emergence of multidrugresistant (MDR) strains.

The purpose of our study was to investigate the prevalence of MDR bacteremia in HSCT recipients at the Tunisian National Bone Marrow Transplant Center (NBMTC), the associated factors and the attributable mortality rate.

Patients/methods: This is a retrospective study which included all MDR bacteremia in the Hematology department, occurring between January 2010 and December 2017.

Results: The prevalence of MDR bacteremia among HSCT recipients was 5.9% (48/816) with a stable trend over time (rs=0.18; p=0.6). Neutropenia, prior hospitalization, prior antibiotherapy and prior colonization with MDR pathogens were observed in 59%, 58%, 48% and 31% of cases, respectively. Imipenem was the most prescribed first-line antibiotic (50%). The first-line antibiotherapy was adequate in 44% of bacteremia. The mortality rate due to MDR bacteremia was 13%. The MDR bacteria (n=48) belonged to ESBL-E (60%) followed by MDR P. aeruginosa (19%), MDR A. baumannii (13%), MRSA (4%) and VRE (4%). For ESBL-E and P. aeruginosa, the rates of antibiotic resistance were respectively, 17% and 44% to imipenem, 31% and 56% to amikacin and 15% and 0% to colistin. Strains of A. baumannii were susceptible only to colistin. The MRSA (n=2) were resistant to ciprofloxacin and gentamicin and susceptible to glycopeptides. The VRE (n=2) were susceptible to linezolid and tigecycline.

Conclusion: Low prevalence of MDR bacteremia in HSCT recipients but high attributable mortality rate, requiring continued screening and reinforcement of hygiene measures.