Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units
Document title: Effectiveness of surveillance cultures for high priority multidrug-resistant bacteria in hematopoietic stem cell transplant units
Journal: Revista do Instituto de Medicina Tropical de Sao Paulo
Database:
System number: 000537155
ISSN: 0036-4665
Authors: 1
2
3
2
2
2
2
2
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2
Institutions: 1Pontifícia Universidade Católica de Campinas, Centro de Ciências da Vida, Campinas, São Paulo. Brasil
2Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo. Brasil
3Universidade do Rio Verde, Hospital de Doenças Tropicais, Aparecida de Goiânia, Goiás. Brasil
Year:
Volumen: 63
Country: Brasil
Language: Inglés
English 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.
Keyword: Hematopoietic stem cell transplant infection,
Hospital-acquired infection,
Multidrug-resistant organisms,
Surveillance cultures,
Blood stream infection
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