Clinical outcomes of persistent colonization with multidrug-resistant Gram-negative rods in adult patients undergoing single cord blood transplantation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2020-03-14

AUTHORS

Mai Mizusawa, Takaaki Konuma, Seiko Kato, Masamichi Isobe, Hiroko Shibata, Masato Suzuki, Osamu Takahashi, Maki Oiwa-Monna, Satoshi Takahashi, Arinobu Tojo

ABSTRACT

Severe bacterial infections are a serious problem after cord blood transplantation (CBT). Colonization with multidrug-resistant Gram-negative rods (MRGNR) is associated with increased morbidity and mortality after allogeneic hematopoietic cell transplantation. However, its impact on outcomes after CBT is unclear. We aim to explore the impact of colonization with MRGNRs in adult patients undergoing CBT. We retrospectively analyzed 145 adult patients who received single-unit CBT in our institute. As a standard practice in our institute, all patients were screened for colonization with MRGNR by oral cavity swabs, urine, and stool specimens between the day of admission for CBT and the day of discharge or day 100 after CBT. There were 62 incidents of colonization with MRGNR in 52 patients, of which 25 involved Stenotrophomonas maltophilia, 19 multidrug-resistant Pseudomonas spp., and 18 extended-spectrum beta-lactamase-producing Enterobacteriaceae. On multivariate analysis, MRGNR persistence significantly affected increase in non-relapse mortality (NRM) (hazard ratio [HR], 8.96; 95% CI 1.85–43.46; P = 0.006) and the subsequent development of bloodstream infection due to MRGNR (HR 11.82; 95% CI 2.15–64.87; P = 0.004), but not MRGNR clearance, compared with non-colonized patients. These data suggest that persistent colonization with MRGNR is significantly associated with higher NRM in CBT for adults. More... »

PAGES

858-868

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12185-020-02854-5

DOI

http://dx.doi.org/10.1007/s12185-020-02854-5

DIMENSIONS

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PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32172445


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31 schema:description Severe bacterial infections are a serious problem after cord blood transplantation (CBT). Colonization with multidrug-resistant Gram-negative rods (MRGNR) is associated with increased morbidity and mortality after allogeneic hematopoietic cell transplantation. However, its impact on outcomes after CBT is unclear. We aim to explore the impact of colonization with MRGNRs in adult patients undergoing CBT. We retrospectively analyzed 145 adult patients who received single-unit CBT in our institute. As a standard practice in our institute, all patients were screened for colonization with MRGNR by oral cavity swabs, urine, and stool specimens between the day of admission for CBT and the day of discharge or day 100 after CBT. There were 62 incidents of colonization with MRGNR in 52 patients, of which 25 involved Stenotrophomonas maltophilia, 19 multidrug-resistant Pseudomonas spp., and 18 extended-spectrum beta-lactamase-producing Enterobacteriaceae. On multivariate analysis, MRGNR persistence significantly affected increase in non-relapse mortality (NRM) (hazard ratio [HR], 8.96; 95% CI 1.85–43.46; P = 0.006) and the subsequent development of bloodstream infection due to MRGNR (HR 11.82; 95% CI 2.15–64.87; P = 0.004), but not MRGNR clearance, compared with non-colonized patients. These data suggest that persistent colonization with MRGNR is significantly associated with higher NRM in CBT for adults.
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38 Gram-negative rods
39 Institute
40 Pseudomonas spp
41 Stenotrophomonas maltophilia
42 admission
43 adult patients
44 adults
45 allogeneic hematopoietic cell transplantation
46 analysis
47 bacterial infections
48 blood transplantation
49 bloodstream infections
50 cell transplantation
51 clearance
52 clinical outcomes
53 colonization
54 cord blood transplantation
55 data
56 day 100
57 day of admission
58 days
59 days of discharge
60 development
61 discharge
62 hematopoietic cell transplantation
63 higher non-relapse mortality
64 impact
65 impact of colonization
66 incidents
67 increase
68 infection
69 maltophilia
70 morbidity
71 mortality
72 multidrug-resistant Gram-negative rods
73 multidrug-resistant Pseudomonas spp
74 multivariate analysis
75 non-colonized patients
76 non-relapse mortality
77 oral cavity swabs
78 outcomes
79 patients
80 persistence
81 persistent colonization
82 practice
83 problem
84 rods
85 serious problem
86 severe bacterial infections
87 single cord blood transplantation
88 single-unit cord blood transplantation
89 specimens
90 spp
91 standard practice
92 stool specimens
93 subsequent development
94 swabs
95 transplantation
96 urine
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