Rectal colonization by multidrug-resistant Gram-negative bacteria and subsequent bacteraemia in haematological patients.

IF 8.5 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2025-06-05 DOI:10.1016/j.cmi.2025.05.033

Antonio Gallardo-Pizarro, Carlos Lopera, Olivier Peyrony, Patricia Monzo-Gallo, Tommaso Francesco Aiello, Ana Martinez-Urrea, Sabina Herrera, Ana Del Río, Christian Teijon-Lumbreras, Mariana Chumbita, Carlos Jimenez-Vicente, Albert Cortés, Marta Bodro, Cristina Pitart, Elisa Rubio, Josep Mensa, Alex Soriano, Jose Antonio Martínez, Carolina Garcia-Vidal

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引用次数: 0

Abstract

Objectives: This study assessed the prevalence of multidrug-resistant Gram-negative bacilli (MDR-GNB) colonization in rectal swabs from haematological patients with malignancies undergoing routine surveillance and explored the relationship between MDR-GNB colonization and subsequent development of bloodstream infections (BSIs).

Methods: Between January 2020 and September 2022, all patients admitted to our haematology ward underwent weekly MDR-GNB colonization screening via rectal swabs. A retrospective analysis was performed. MDR-GNB were defined per 2022 European Society of Clinical Microbiology and Infectious Diseases criteria: (a) third-generation cephalosporin-resistant Enterobacterales (3GCephRE), (b) carbapenem-resistant Enterobacterales (CRE), (c) Pseudomonas aeruginosa with difficult-to-treat resistance (DTR), and (d) carbapenem-resistant Acinetobacter baumannii.

Results: Among 3024 rectal swabs from 699 patients, 503 of 3024 (16.6%) tested positive for MDR-GNB in 192 of 699 patients (27.5%). The most prevalent organisms were Escherichia coli (248/503; 49.3%), Klebsiella pneumoniae complex (125/503; 24.9%), and P. aeruginosa (36/503; 7.2%). A total of 59 of 503 (11.7%) colonizations of CRE were identified. Overall, 27 of 192 (14.1%) patients were colonized at admission, primarily by 3GCephRE (27/29; 93.1%). Colonization with CRE and DTR P. aeruginosa was more frequently documented after several days of hospitalization. BSI occurred in 74 of 192 (38.5%) colonized and 61 of 507 (12.0%) non-colonized patients. MDR-GNB caused 57 of 166 BSIs episodes, 50 of 57 (87.7%) of which were in colonized patients. The unadjusted concordance rate between rectal swab isolates and blood cultures was observed in 43 of 90 BSIs (47.8%) occurring in colonized patients, with a positive predictive value (PPV) of 36.4% and a negative predictive value (NPV) of 99.9% for DTR P. aeruginosa; a PPV of 25.0% and an NPV of 99.9% for CRE; and a PPV of 14.6% and an NPV of 99.0% for 3GCephRE.

Discussion: Routine weekly surveillance for MDR-GNB in haematological patients enables early identification of colonization, often preceding MDR-GNB BSIs. Further studies using adjusted analyses are needed to establish its independent predictive value.

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多药耐药革兰氏阴性菌的直肠定植和血液病患者随后的菌血症。

目的：本研究评估了接受常规监测的恶性血液病患者直肠拭子中耐多药革兰氏阴性杆菌（MDR-GNB）定植的流行情况，并探讨了MDR-GNB定植与随后发展为血流感染（bsi）之间的关系。方法：在2020年1月至2022年9月期间，我们血液科病房的所有患者每周通过直肠拭子进行耐多药gnb定植筛查。进行回顾性分析。MDR-GNB是根据2022年ESCMID标准定义的：(i)第三代头孢菌素耐药肠杆菌（3GCephRE），（ii）碳青霉烯耐药肠杆菌（CRE），（iii）难以治疗的铜绿假单胞菌（DTR），（iv）耐碳青霉烯鲍曼不动杆菌（CRAB）。结果：在699例患者的3024份直肠拭子中，302 / 3024例（16.6%）耐多药gnb阳性，192/699例（27.5%）。最常见的细菌是大肠杆菌(248/503；49.3%)，肺炎克雷伯菌复合体(125/503；24.9%)， P. aeruginosa (36/503；7.2%)。共鉴定出59/503个（11.7%）CRE定植。总体而言，27/192（14.1%）患者在入院时定植，主要是3GCephRE (27/29；93.1%)。CRE和DTR铜绿假单胞菌的定植在住院几天后更为常见。BSI发生率为74/192（38.5%）定植患者和61/507（12.0%）非定植患者。MDR-GNB导致57/166例BSIs发作，其中50/57例（87.7%）发生在定植患者中。在定植的患者中，43/90例bsi（47.8%）的直肠棉签分离物与血培养物的未调整一致性，DTR铜绿假单胞菌的阳性预测值（PPV）为36.4%，阴性预测值（NPV）为99.9%；商业地产的PPV为25.0%，净现值为99.9%；3gcepre的PPV为14.6%，NPV为99.0%。结论：血液学患者每周常规监测耐多药gnb可早期识别定植，通常在耐多药gnb BSIs之前。需要进一步使用调整分析的研究来确定其独立的预测值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.