Journal article
Impact of broad-spectrum antibiotic exposures and multidrug-resistant gram-negative bacteremia on hematopoietic cell transplantation outcomes
Transplant infectious disease, Vol.23(5), pp.e13717-n/a
10/01/2021
DOI: 10.1111/tid.13717
PMID: 34431187
Abstract
Introduction There is a close association between the use of broad-spectrum antibiotics, gut microbiome alteration, multidrug resistant (MDR) gram-negative bacilli (GNB) bacteremia, graft versus host disease (GVHD), and mortality post-allogeneic hematopoietic cell transplantation (allo-HCT). This study reports the impact of the high use of carbapenems and colistin and MDR bacteremia pre- and post-HCT on HCT outcomes. Methods This was a single-center, partial retrospective, and prospective study from 2016 to 2020. Both pre- and post-HCT antibiotic exposures and blood culture/sensitivity were recorded. MDR GNB was defined as either non-susceptibility to third-generation cephalosporin or carbapenems. In the absence of positive cultures, the treating physician escalated antibiotics from third-generation cephalosporins to carbapenem and/or colistin as per clinical discretion. De-escalation policy was not strictly enforced. Results MDR GNB bacteremia was seen in 29 of 76 (38%) of patients peri-HCT. The utilization rates for carbapenems and colistin was significantly higher in the cohort with MDR GNB bacteremia pre-HCT (70% vs. 32%, p = 0.002 and 31% vs. 6.4%, p = 0.007, respectively) and post-HCT (100% vs. 74.5%, p = 0.002, and 55.2% vs. 8.5%, p < 0.0001, respectively). The cohort with MDR GNB bacteremia had significantly more severe acute GVHD at day+100 (45% vs. 17.5%, p = 0.009). The median survival was 204 days compared to not reached in the cohort without any MDR GNB bacteremia (p = 0.005). Conclusion This study shows pre- and post-HCT MDR GNB bacteremia is associated with an increased risk of severe acute GVHD and mortality. Patients with MDR GNB bacteremia had higher exposure to pre- and post-HCT carbapenems and colistin.
Details
- Title: Subtitle
- Impact of broad-spectrum antibiotic exposures and multidrug-resistant gram-negative bacteremia on hematopoietic cell transplantation outcomes
- Creators
- Shaweta Kaundal - Post Graduate Institute of Medical Education and ResearchAditya Jandial - Post Graduate Institute of Medical Education and ResearchHarmandeep Singh - Post Graduate Institute of Medical Education and ResearchMadhu Chopra - Post Graduate Institute of Medical Education and ResearchKripa Shanker Kasudhan - Post Graduate Institute of Medical Education and ResearchNiranjan Khaire - Post Graduate Institute of Medical Education and ResearchAlka Khadwal - Post Graduate Institute of Medical Education and ResearchGaurav Prakash - Post Graduate Institute of Medical Education and ResearchArihant Jain - Post Graduate Institute of Medical Education and ResearchVikas Suri - Post Graduate Institute of Medical Education and ResearchAmol Patil - Post Graduate Institute of Medical Education and ResearchAmit Arora - Post Graduate Institute of Medical Education and ResearchVishal Sharma - Post Graduate Institute of Medical Education and ResearchPallab Ray - Post Graduate Institute of Medical Education and ResearchPankaj Malhotra - Post Graduate Institute of Medical Education and ResearchDeepesh P. Lad - Post Graduate Institute of Medical Education and Research
- Resource Type
- Journal article
- Publication Details
- Transplant infectious disease, Vol.23(5), pp.e13717-n/a
- DOI
- 10.1111/tid.13717
- PMID
- 34431187
- ISSN
- 1398-2273
- eISSN
- 1399-3062
- Publisher
- Wiley
- Number of pages
- 6
- Grant note
- 2020-0664 / Indian Council of Medical Research; Indian Council of Medical Research (ICMR)
- Language
- English
- Date published
- 10/01/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985237607702771
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