scholarly journals Clostridium Difficile Infection after Allogeneic Hematopoietic Stem Cell Transplant: Strain Diversity and Outcomes Associated with NAP1/027

2014 ◽  
Vol 20 (10) ◽  
pp. 1626-1633 ◽  
Author(s):  
Mini Kamboj ◽  
Kun Xiao ◽  
Anna Kaltsas ◽  
Yao-Ting Huang ◽  
Janet Sun ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Hematopoietic Stem Cell ◽  
Clostridium Difficile Infection ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Strain Diversity

scholarly journals BACTERIAL INFECTIONS IN HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS

2015 ◽  
Vol 7 ◽  
pp. e2015045 ◽  
Author(s):  
Elisa Balletto ◽  
Malorzata Mikulska
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Febrile Neutropenia ◽  
Hematopoietic Stem Cell ◽  
Bacterial Infections ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Resistant Bacteria ◽  
Cell Transplant ◽  
Hematopoietic Stem

Bacterial infections are major complications after Hematopoietic Stem Cell Transplant (HSCT). They consist mainly of bloodstream infections (BSI), followed by pneumonia and gastrointestinal infections, including typhlitis and Clostridium difficile infection. Microbiological data come mostly from BSI. Coagulase negative staphylococci and Enterobacteriaceae are the most frequent pathogens causing approximately 25% of BSI each, followed by enterococci, P. aeruginosa and viridans streptococci. Bacterial pneumonia is frequent after HSCT, and Gram-negatives are predominant. Clostridium difficile infection affects approximately 15% of HSCT recipients, being more frequent in case of allogeneic than autologous HSCT.The epidemiology and the prevalence of resistant strains vary significantly between transplant centres. In some regions, multi-drug resistant Gram-negative rods are increasingly frequent. In others, vancomycin-resistant enterococci are predominant. In the era of an increasing resistance to antibiotics, the efficacy of fluoroquinolone prophylaxis and standard treatment of febrile neutropenia have been questioned. Therefore, thorough evaluation of local epidemiology is mandatory in order to decide the need for prophylaxis and the choice of the best regimen for empirical treatment of febrile neutropenia. For the latter, individualised approach has been proposed, consisting of either escalation or de-escalation strategy. De-escalation strategy is recommended is resistant bacteria should be covered upfront, mainly in patients with severe clinical presentation and previous infection or colonisation with a resistant pathogens.Non-pharmacological interventions, such as screening for resistant bacteria, applying isolation and contact precautions should be put in place in order to limit the spread of MDR bacteria. Antimicrobial stewardship program should be implemented in transplant centres.

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