scholarly journals Outbreak of Pseudomonas aeruginosa Bacteremia Infections among Stem-Cell Transplant Patients Related to Change in Prophylaxis

2021 ◽  
Vol 1 (S1) ◽  
pp. s25-s26
Author(s):  
Kerrie VerLee ◽  
Chau Nguyen ◽  
Russell Lampen ◽  
Jim Codman ◽  
Tunisia Peters
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Blood Cultures ◽  
Incidence Density ◽  
Common Source ◽  
Cell Transplant ◽  
Environmental Isolates ◽  
Point Of Use ◽  
Fluoroquinolone Prophylaxis

Background:Pseudomonas aeruginosa outbreaks can originate from various sources and can cause severe complications in posttransplant patients. Antibiotic prophylaxis can decrease posttransplant infections; however, consideration must be given to P. aeruginosa coverage as we outline an outbreak among the stem-cell transplant (SCT) population. Methods: A multidisciplinary outbreak investigation was conducted to evaluate sources of contamination and changes in clinical processes. Positive blood cultures from SCT patients and environmental isolates were analyzed using whole-genome sequencing (WGS). Incidence density rates for P. aeruginosa blood cultures from January 2019 through October 2020 were calculated per 10,000 patient days and stratified by unit, specimen, and transplant type. Statistical analysis was calculated with significance at p < 0.05. Results: A cluster of 8 SCT patients was identified between May and September 2020. Moreover, 10 environmental samples were positive for P. aeruginosa including drains, water sources prior to the point-of-use (POU) filter and blood-bank thaw machines. Phylogenetic analysis revealed 1 cluster of 2 patients who shared the same room, 5 patients with unique P. aeruginosa isolates, and 2 separate clusters of environmental isolates with relatedness only to each other. Review of clinical processes showed a change from fluoroquinolone prophylaxis to cephalosporin in the spring of 2020. Also, 5 P. aeruginosa bacteremia infections occurred prior to June (11.78 cases per 10,000 patient days). During the period of cephalosporin use, 8 infections were identified (58.27 cases per 10,000 patient days) (P = .006). Following the restart of fluoroquinolone, zero infections have occurred to date, as of January 28, 2021. Conclusions: Discontinuation of fluoroquinolone prophylaxis was associated with P. aeruginosa bacteremia infections in SCT patients. Use of fluoroquinolone prophylaxis in SCT patients is protective from P. aeruginosa bacteremia infections. There have been no further infections in the following 3 months after the change back to the use of fluoroquinolone. Additionally, WGS showed that most patient isolates did not have a common source, suggesting that P. aeruginosa gastrointestinal colonization may play a role in seeding these bacteremia infections.Funding: NoDisclosures: None

scholarly journals A Serious Complication of Allogeneic Stem Cell Transplantation: Relapsing Pseudomonas aeruginosa Panniculitis

2007 ◽  
Vol 1 ◽  
pp. 117955490700100
Author(s):  
Celalettin Ustun ◽  
Stephanie Farrow ◽  
Mohamed El-Geneidy ◽  
David Deremer ◽  
Anand Jillella
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Stem Cell ◽  
Antibiotic Treatment ◽  
Stem Cell Transplant ◽  
Blood Cultures ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Subcutaneous Nodules ◽  
Gentamicin Treatment

A 58-year-old female following an allogeneic stem cell transplant (alloSCT) presented with tender subcutaneous nodule in the axillary and inguinal regions. One of the nodules was biopsied and cultured. The patient was diagnosed with Pseudomonas aeruginosa ( P. aeruginosa) panniculitis. Blood cultures were negative for P. aeruginosa. The patient responded to 4 weeks of imipenem-cilastatin and gentamicin treatment but relapsed immediately after the discontinuation of antibiotic treatment with a change in the susceptibility of P. aeruginosa to antibiotics. The patient received piperacillin-tazobactam and aztreonam with no recurrence for nine months. Differential diagnosis of subcutaneous nodules can be difficult in an alloSCT setting. P. aeruginosa should be kept in mind, and the biopsy and culture of a nodule should be obtained without delay. Blood cultures can be negative. Despite long term antibiotic treatment, relapse can occur.

Multi-Drug Resistant Organisms Are Common in Fecal Surveillance Cultures and Do Not Predict Bacteremia but Correlate with Poorer Outcomes in Patients Undergoing Allogeneic Stem Cell Transplants

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3406-3406
Author(s):  
Vikram Mathews ◽  
Alok Srivastava ◽  
Biju George ◽  
Anu Korula ◽  
Susmitha Perumalla ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Blood Cultures ◽  
Cell Transplant ◽  
Drug Resistant ◽  
Surveillance Cultures ◽  
Cell Transplants ◽  
Baseline Characteristics ◽  
Grade 3

Abstract Introduction: The use of fecal surveillance cultures in predicting bacteremia in patients undergoing intensive chemotherapy and stem cell transplant is an unsettled issue (Neshar et al. Transpl. Infect Dis. 2015). With the increasing incidence of multi-drug resistant (MDR) organisms and high mortality rates with these infections, we sought to describe the spectrum of MDR identified in fecal surveillance, and re-visit the use of fecal surveillance in predicting infection with MDR organisms post-allogeneic stem cell transplant (allo-SCT). Methods: We analyzed data from all patients who underwent allogeneic stem cell transplant during a 2 year period (2014-2015). Patients with MDR strains of bacteria (defined in this study as defined as Vancomycin resistant enterococcus (VRE), Extended spectrum Beta-Lactamases (ESBL) and Carbapenem resistant enterobacteriacea (CRE)) in fecal surveillance were compared with patients who did not have MDR in fecal surveillance cultures. Baseline characteristics and post allo-SCT outcomes including MDR blood culture positivity, severe sepsis and 100-day transplant related mortality (TRM) were compared. Multivariate analysis using logistic regression model was used to determine independent predictors of outcome. Results: A total of 313 allogeneic stem cell transplants were performed in 299 patients, of which data on pre-transplant fecal surveillance cultures were available in 232 transplants. The incidence of MDR isolates in fecal surveillance cultures was 56% (134/232, with E.Coli 118, Klebsiella 33 and Enterococcus 13). Of these, 129 were ESBL alone (78.6%), 17 were CRE alone (10.3%), 10 were ESBL + CRE (6%), 6 (3.6%) were VRE alone. More than one drug resistant organism was isolated in fecal surveillance in 31 patients. The incidence of any MDR positivity in post-transplant blood cultures in all patients was 13.8% (32/232), with 9.4% CRE, 2.6% ESBL, and 1.7% VRE. Thirty-one patients had severe sepsis without any MDR organism isolated on blood culture, but of these 3 had CRE in sputum, 2 had Colistin resistant Acetinobacter (sputum), 2 had candidemia, 3 had NF-GNB and one had Enterococcus. Baseline characteristics between patients who were positive and negative for MDR in fecal surveillance were similar in relation in relation to age (p=0.058), diagnosis (0.133), type of transplant - matched family/MUD/Haplo (p=0.610), stem cell source (0.370), grade 3-4 GVHD (0.834). There was a significantly higher subsequent blood MDR positivity (any MDR) (p=0.012), 100-day mortality (p=0.012) and poor outcome (severe sepsis or 100 day mortality) (p=0.006) in patients who had MDR detected in fecal surveillance cultures. However, of the 25 patients who had MDR isolated in both fecal surveillance culture as well as subsequent blood cultures, only 9 patients had the same organism and susceptibility pattern in both. Factors influencing 100-day mortality included patient's age (p=0.001), MDR positivity in blood (p=0.0001), MDR in fecal surveillance (p=0.01), use of an alternate (Haplo/MUD/family) donor (p=0.0001), GVHD grade 3-4 (p=0.000) and severe sepsis (p=0.000). On multivariate analysis, only patient's age (p=0.015), alternate donor (0.009), severe sepsis (p=0.000) and grade 3-4 GVHD (p=0.001) retained significance in predicting 100-day mortality. Conclusion: Multidrug resistant organisms are frequently seen on fecal surveillance in the pre-transplant setting. MDR in fecal surveillance is associated with a higher incidence of MDR positive blood cultures but not with the same organism, and on univariate analysis is associated with higher incidence of 100 day mortality. Newer strategies to reduce bacteremia and mortality in this group of high risk patients need to be considered. Disclosures No relevant conflicts of interest to declare.

scholarly journals Fluoroquinolone Prophylaxis in Autologous Hematopoietic Stem Cell Transplant Recipients

2016 ◽  
Vol 22 (3) ◽  
pp. S128-S129
Author(s):  
Dipenkumar Modi ◽  
Abhinav Deol ◽  
Lois Jeanne Ayash ◽  
Voravit Ratanatharathorn ◽  
Seongho Kim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem ◽  
Fluoroquinolone Prophylaxis

scholarly journals Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients

2017 ◽  
Vol 25 (8) ◽  
pp. 2593-2601 ◽  
Author(s):  
Dipenkumar Modi ◽  
Hyejeong Jang ◽  
Seongho Kim ◽  
Malini Surapaneni ◽  
Kamya Sankar ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem ◽  
Fluoroquinolone Prophylaxis

scholarly journals Incidence and Risk Factors for Developing Herpes Zoster Among a Cohort of Patients Diagnosed with Lymphoma at a Community Cancer Center

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3589-3589
Author(s):  
Yamila Goenaga Vazquez ◽  
Joel Rivera Concepcion ◽  
Fernando Cabanillas
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Stem Cell ◽  
Herpes Zoster ◽  
Stem Cell Transplant ◽  
Incidence Density ◽  
Cancer Center ◽  
Cell Transplant ◽  
Immunocompromised Patients ◽  
Stage At Diagnosis

Abstract Introduction Lymphoid neoplasms are among the most common hematologic malignancies. Viral infections are important causes of mortality and morbidity in patients with lymphoma. The majority of viral infectious complications in these patients result from the reactivation of various viruses such as Herpes Zoster (HZ). Most cases of HZ are self-limited; however, immunocompromised patients have a higher mortality rate from HZ and are at greater risk for recurrences and more serious and atypical complications. The most important established risk factors for developing HZ in cancer patients include neutropenia, duration and intensity of treatment, type of chemotherapy received, comorbid conditions such as Diabetes Mellitus, being recipient of a stem cell transplant, among others. However, the impact of baseline laboratory characteristics such as absolute lymphocyte count (ALC) and lactate dehydrogenase (LDH) as well as the cell type and stage of lymphoma at diagnosis on the risk of developing HZ remains unclear. Anecdotal data suggest that prophylaxis with acyclovir might be beneficial to decrease the incidence of HZ among patients with lymphoma receiving chemotherapy. Although it is well known that the two FDA-approved HZ vaccines decrease the incidence of this condition in immunocompetent hosts, the Advisory Committee on Immunization Practices has not made recommendations regarding its use in immunocompromised patients. In view of the debilitating condition of lymphoma patients and the unclear effectiveness of anti-HZ vaccine in this disorder, it seems urgent to find better preventive and treatment strategies. Materials and methods We conducted a retrospective cohort study of patients diagnosed with lymphoma registered in the database of Auxilio Mutuo Cancer Center (AMCC). Our study analyzed the incidence of HZ in patients diagnosed with lymphoma at any time during the course of illness. The duration of this study was from 1997-2017. The variables were the following: gender, age >50 at diagnosis, type of chemotherapy, having diabetes mellitus, having received an autologous stem cell transplant (ASCT), multiple courses of chemotherapy, radiotherapy, rituximab, or what we labeled as "highly immunosuppressive chemotherapy (HIC)", date of relapse or death, stage at diagnosis, indolent or aggressive presentation, baseline LDH, baseline ALC<1000, and date of HZ. The frequencies of each categorical variable were compared with chi-square tests (χ2 test) or Fisher's exact tests. All statistical analyses were based on two-sided hypothesis tests with a significance level of P< 0.05. Results From 1997-2017 there were 414 lymphoma patients with median age at diagnosis of 53 years. There were 90 patients with HD, 6 patients with NK/T-cell lymphoma, and 319 with NHL. During a median follow up of 10 years a total of 46 HZ cases were identified for an overall incidence density of 11.2%. Higher rates of HZ were associated with the following factors: multiple courses of chemotherapy (p=0.035), indolent lymphoma (p=0.012), advanced stage at diagnosis (p=0.034), having received HIC (p<0.001), and having lymphopenia at the time of diagnosis (p=0.038). The other variables studied did not exhibit higher rates of HZ. Discussion Our study is one of the first to estimate incidence rates of HZ and examine risk factors and complications of HZ in lymphoma patients according to specific histologic subtype and presentation. The overall incidence among all groups was significantly higher than in the general population. We have documented that HZ incidence varies with treatment regimens and stage of disease at diagnosis as well as presentation of indolent vs aggressive. Lymphocytopenia was not described previously in the literature as a risk factor for developing HZ but in our cohort patients having ALC<1000 at diagnosis displayed a significantly higher incidence of HZ. The patients who received multiple courses of chemotherapy and HIC also exhibited significantly elevated risks for HZ. Because the overall incidence of HZ was higher among the patients with lymphoma during chemotherapy, prophylaxes against HZmight be considered, particularly for patients with the risk factors. However, optimal duration and preferred regimen for prophylaxis remain to be elucidated. Disclosures No relevant conflicts of interest to declare.

scholarly journals Persistence of a Positive (1,3)-β-d-Glucan Test after Clearance of Candidemia in Hematopoietic Stem Cell Transplant Recipients

2011 ◽  
Vol 18 (3) ◽  
pp. 518-519 ◽  
Author(s):  
M. Mikulska ◽  
E. Furfaro ◽  
V. Del Bono ◽  
F. Gualandi ◽  
M. T. Van Lint ◽  
...  
Keyword(s):  
Stem Cell ◽  
Blood Culture ◽  
Hematopoietic Stem Cell ◽  
Positive Blood Culture ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Blood Cultures ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem

ABSTRACTIn 6 hematopoietic stem cell transplant (HSCT) recipients with candidemia, the (1,3)-β-d-glucan (BG) test was positive a median of 2.5 days after a positive blood culture. Only in 1 patient did BG positivity precede positive blood cultures. BG concentrations decreased in patients with clinical response, but positive BG results persisted long after blood cultures became sterile (median, 48 days).

Clusters of infection due to metallo-β-lactamase-producing Pseudomonas aeruginosa in stem cell transplant and haematology units

2011 ◽  
Vol 77 (1) ◽  
pp. 76-77 ◽  
Author(s):  
J. Paez ◽  
A.S. Levin ◽  
L. Fu ◽  
M. Basso ◽  
G.H.H. Fonseca ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant
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