Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units

Authors

  • Elisa Teixeira Mendes Pontifícia Universidade Católica de Campinas, Centro de Ciências da Vida, Programa de Pós-Graduação em Ciências da Saúde, Campinas, São Paulo, Brazil http://orcid.org/0000-0003-4251-8185
  • Mariana Graça Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Microbiologia, São Paulo, São Paulo, Brazil
  • Flavia Rossi Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório Central, Divisão de Microbiologia, São Paulo, São Paulo, Brazil
  • Fernanda Sapadao Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
  • Thais Guimarães Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
  • Vanderson Rocha Universidade de São Paulo, Faculdade de Medicina, Departamento de Hematologia e Hemoterapia, São Paulo, São Paulo, Brazil
  • Silvia Figueiredo Costa Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Microbiologia, São Paulo, São Paulo, Brazil http://orcid.org/0000-0003-1087-752X

DOI:

https://doi.org/10.1590/S1678-9946202163077

Keywords:

Hematopoietic stem cell transplant infection, Hospital-acquired infection, Multidrug-resistant organisms, Surveillance cultures, Blood stream infection

Abstract

Surveillance strategies to detect colonization are an important tool to prevent and control the spread of microorganisms in hematopoietic stem cell transplant (HSCT) units. The aim of this study was to evaluate routine surveillance cultures for screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa), and vancomycin-resistant enterococci (VRE). Surveillance cultures were collected (1,323 samples) from 200 patients admitted to an HSCT unit over one year; swabs were taken on admission and then weekly. We compared the positivity of cultures for each site, agent, clinical and epidemiological data according to the colonization status. Infection due to multidrug-resistant organisms (MDROs) occurred in 52 (21.5%) patients, 45 (86.5%) due to blood stream infection; 12 (23%) patients had a positive surveillance culture before the infection. Cultures of 554 (41.8%) samples were performed for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 (13.5%) were positive. Colonization by any MDRO, CRE or CRPa was associated with increased risk of infection (P < 0.05), but not with death. Previous colonization by an MDRO was a significant risk for infection by these pathogens, specially by CRE. Overall, rectal swabs had the highest positivity rate compared with other sites, oropharynx swabs were an option for CRPa, and fecal cultures showed low positivity. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, routine VRE surveillance should be questioned with regard to patients undergoing auto-HSCT due to the additional cost and little impact on survival rates.

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Published

2021-11-12

Issue

Section

Original Article

How to Cite

Mendes, E. T. ., Graça, M. ., Rossi, F. ., Sapadao , F. ., Guimarães, T. ., Rocha, V. ., & Costa, S. F. (2021). Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units. Revista Do Instituto De Medicina Tropical De São Paulo, 63, e77. https://doi.org/10.1590/S1678-9946202163077