Sung-Woon Kang, So Yun Lim, Euijin Chang, Jiwon Jung, Yong Pil Chong, Hyunkyung Park, Han-Seung Park, Yunsuk Choi, Jung-Hee Lee, Je-Hwan Lee, Sung-Han Kim
{"title":"产碳青霉烯酶肠杆菌在造血干细胞移植受者中的定植和产碳青霉烯酶肠杆菌血症的风险。","authors":"Sung-Woon Kang, So Yun Lim, Euijin Chang, Jiwon Jung, Yong Pil Chong, Hyunkyung Park, Han-Seung Park, Yunsuk Choi, Jung-Hee Lee, Je-Hwan Lee, Sung-Han Kim","doi":"10.1093/ofid/ofaf516","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Carbapenemase-producing <i>Enterobacteriaceae</i> (CPE) are globally concerning pathogens due to limited therapeutic options. Despite the increasing incidence of CPE infections, evidence supporting effective empirical treatments for individuals undergoing hematopoietic stem cell transplantation (HSCT) remains limited.</p><p><strong>Methods: </strong>From January 2019 to December 2023, individuals undergoing HSCT screened for CPE colonization via perianal swabs upon admission before HSCT were retrospectively analyzed. Culture-based identification and carbapenemase-specific polymerase chain reaction were performed. The occurrence of <i>Enterobacteriaceae</i> bacteremia within 100 days post-HSCT was monitored. Propensity-score (PS) matching and competing risk analyses were used to evaluate the relationship between CPE colonization and bacteremia risk.</p><p><strong>Results: </strong>Among 649 patients undergoing HSCT, 70 (11%) were colonized with CPE. <i>Enterobacteriaceae</i> bacteremia occurred in 20 (29%) CPE-colonized and 56 (10%) noncolonized individuals (<i>P</i> < .001). Among these cases, 17/20 (85%) in the colonized group and 12/56 (21%) in the noncolonized group were caused by CPE (<i>P</i> < .001). After 1:2 PS matching, these rates remained consistent (85% vs 22%, <i>P</i> = .004). All CPE isolates recovered from blood were identical in species and carbapenemase type to those detected in pre-HSCT swabs. Competing risk analyses showed that pre-HSCT CPE colonization was significantly associated with CPE bacteremia (subdistribution hazard ratio [sHR] 13.1, 95% confidence interval [CI] 6.27-27.3, <i>P</i> < .001; after matching: sHR 19.1, 95% CI 4.42-82.20, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Pre-HSCT CPE colonization increases <i>Enterobacteriaceae</i> bacteremia risk. Routine screening and empirical CPE-directed therapy are essential to improving clinical outcomes.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf516"},"PeriodicalIF":3.8000,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418090/pdf/","citationCount":"0","resultStr":"{\"title\":\"Carbapenemase-Producing <i>Enterobacteriaceae</i> Colonization and the Risk of Carbapenemase-Producing <i>Enterobacteriaceae</i> Bacteremia in Hematopoietic Stem Cell Transplant Recipients.\",\"authors\":\"Sung-Woon Kang, So Yun Lim, Euijin Chang, Jiwon Jung, Yong Pil Chong, Hyunkyung Park, Han-Seung Park, Yunsuk Choi, Jung-Hee Lee, Je-Hwan Lee, Sung-Han Kim\",\"doi\":\"10.1093/ofid/ofaf516\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Carbapenemase-producing <i>Enterobacteriaceae</i> (CPE) are globally concerning pathogens due to limited therapeutic options. Despite the increasing incidence of CPE infections, evidence supporting effective empirical treatments for individuals undergoing hematopoietic stem cell transplantation (HSCT) remains limited.</p><p><strong>Methods: </strong>From January 2019 to December 2023, individuals undergoing HSCT screened for CPE colonization via perianal swabs upon admission before HSCT were retrospectively analyzed. Culture-based identification and carbapenemase-specific polymerase chain reaction were performed. The occurrence of <i>Enterobacteriaceae</i> bacteremia within 100 days post-HSCT was monitored. Propensity-score (PS) matching and competing risk analyses were used to evaluate the relationship between CPE colonization and bacteremia risk.</p><p><strong>Results: </strong>Among 649 patients undergoing HSCT, 70 (11%) were colonized with CPE. <i>Enterobacteriaceae</i> bacteremia occurred in 20 (29%) CPE-colonized and 56 (10%) noncolonized individuals (<i>P</i> < .001). Among these cases, 17/20 (85%) in the colonized group and 12/56 (21%) in the noncolonized group were caused by CPE (<i>P</i> < .001). After 1:2 PS matching, these rates remained consistent (85% vs 22%, <i>P</i> = .004). All CPE isolates recovered from blood were identical in species and carbapenemase type to those detected in pre-HSCT swabs. Competing risk analyses showed that pre-HSCT CPE colonization was significantly associated with CPE bacteremia (subdistribution hazard ratio [sHR] 13.1, 95% confidence interval [CI] 6.27-27.3, <i>P</i> < .001; after matching: sHR 19.1, 95% CI 4.42-82.20, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Pre-HSCT CPE colonization increases <i>Enterobacteriaceae</i> bacteremia risk. Routine screening and empirical CPE-directed therapy are essential to improving clinical outcomes.</p>\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":\"12 9\",\"pages\":\"ofaf516\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418090/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf516\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf516","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：产碳青霉烯酶肠杆菌科（CPE）是全球关注的病原体，由于有限的治疗选择。尽管CPE感染的发生率越来越高，但支持对接受造血干细胞移植（HSCT）的个体进行有效经验性治疗的证据仍然有限。方法：回顾性分析2019年1月至2023年12月接受HSCT的患者在入院前通过肛周拭子筛查CPE定植。进行基于培养的鉴定和碳青霉烯酶特异性聚合酶链反应。监测hsct后100天内肠杆菌科菌血症的发生情况。使用倾向评分（PS）匹配和竞争风险分析来评估CPE定植与菌血症风险之间的关系。结果：在649例接受HSCT的患者中，70例（11%）有CPE定植。肠杆菌科菌血症发生在20例（29%）cpe定植个体和56例（10%）非cpe定植个体中（P < 0.001）。其中，定殖组为17/20(85%)，非定殖组为12/56(21%)，差异有统计学意义（P < 0.001）。在1:2 PS匹配后，这些比率保持一致（85% vs 22%, P = 0.004）。从血液中回收的所有CPE分离株在物种和碳青霉烯酶类型上与在hsct前拭子中检测到的CPE分离株相同。竞争风险分析显示，hsct前CPE定殖与CPE菌血症显著相关（亚分布风险比[sHR] 13.1, 95%可信区间[CI] 6.27 ~ 27.3, P < .001；匹配后：sHR 19.1, 95% CI 4.42 ~ 82.20, P < .001）。结论：hsct前CPE定殖增加肠杆菌科菌血症的风险。常规筛查和经验性cpe指导治疗对改善临床结果至关重要。
Carbapenemase-Producing Enterobacteriaceae Colonization and the Risk of Carbapenemase-Producing Enterobacteriaceae Bacteremia in Hematopoietic Stem Cell Transplant Recipients.
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are globally concerning pathogens due to limited therapeutic options. Despite the increasing incidence of CPE infections, evidence supporting effective empirical treatments for individuals undergoing hematopoietic stem cell transplantation (HSCT) remains limited.
Methods: From January 2019 to December 2023, individuals undergoing HSCT screened for CPE colonization via perianal swabs upon admission before HSCT were retrospectively analyzed. Culture-based identification and carbapenemase-specific polymerase chain reaction were performed. The occurrence of Enterobacteriaceae bacteremia within 100 days post-HSCT was monitored. Propensity-score (PS) matching and competing risk analyses were used to evaluate the relationship between CPE colonization and bacteremia risk.
Results: Among 649 patients undergoing HSCT, 70 (11%) were colonized with CPE. Enterobacteriaceae bacteremia occurred in 20 (29%) CPE-colonized and 56 (10%) noncolonized individuals (P < .001). Among these cases, 17/20 (85%) in the colonized group and 12/56 (21%) in the noncolonized group were caused by CPE (P < .001). After 1:2 PS matching, these rates remained consistent (85% vs 22%, P = .004). All CPE isolates recovered from blood were identical in species and carbapenemase type to those detected in pre-HSCT swabs. Competing risk analyses showed that pre-HSCT CPE colonization was significantly associated with CPE bacteremia (subdistribution hazard ratio [sHR] 13.1, 95% confidence interval [CI] 6.27-27.3, P < .001; after matching: sHR 19.1, 95% CI 4.42-82.20, P < .001).
Conclusions: Pre-HSCT CPE colonization increases Enterobacteriaceae bacteremia risk. Routine screening and empirical CPE-directed therapy are essential to improving clinical outcomes.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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