ISSN 1866-8836
Клеточная терапия и трансплантация

PC-05. Comparison of carbapenem-resistant gut colonization surveillance methods in early period of allogeneic hematopoietic stem cell transplantation

Ekaterina D. Markovina, Yuliya A. Rogacheva, Marina O. Popova, Aleksandr A. Siniaev, Oleg V. Goloshchapov, Yulia Yu. Vlasova, Sergey N. Bondarenko, Alexander D. Kulagin

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Contact: Ekaterina D. Markovina, e-mail: katyatasser@gmail.com

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

Gut colonization with carbapenem-resistant bacteria (Carba+) is a risk factor for infectious complications and worse overall outcome in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). To achieve higher effectiveness of early empirical antibiotic therapy it is vital to determine the most efficient method of Carba+ colonization detection. The aim of this study is to compare frequencies of Carba+ detection by three methods, including PCR-tests of rectal swabs for the detection of the major carbapenemase gene families.

Materials and methods

In this study, 25 adult patients who underwent their first allo- HSCT from August to December 2022 were enrolled. A prospective surveillance study of gut colonization was conducted from D-7 to D+35. Standard microbiological assay of feacal samples with the evaluation of antibiotic resistance, rectal swab tests on chromogenic agar (ESBL, Carba+, VRE) and PCR-tests for the detection of the major carbapenemase gene families (VIM, IMP, NDM, KPC and OXA-48-like) were performed weekly. In this study, the medium time of febrile neutropenia (FN) occurrence was D+7 (D0-18). Therefore, D-7 and D0 data were merged in one group. Due to a lethal outcome one patient was excluded at D+14. The episodes of any infectious complications were analyzed weekly, causative agents and antibiotic resistance profiles were compared with the patient’s gut colonization results.

Results

With standard microbiological assay, Carba+ colonization was detected in 5.56% (n=1), 18.75% (n=3), and 38.89% (n=7) of patients on D-7, D0, D+7 and D+35, respectively. In 85.2% of cases, Carba+ Klebsiella pneumoniae was detected. With chromogenic agar technique, Carba+ colonization was detected in 12% (n=3), 17.4% (n=4), 63.2% (n=12) of patients on D-7, D0, D+7 and D+35, respectively. With PCR-tests Carba+, colonization was detected in 43.5% (n=10); 37.5% (n=9); 92.9% (n=13) of the patients on D-7-0, D+7 and D+35, respectively. The NDM gene was detected most frequently (48.76%, n=59). Comparison of PCR-tests results with data from standard microbiological assays and tests on chromogenic agar is presented in Table 1. There were 9 incidences of infectious complications caused by Gram-negative bacteria, including 77.8% (n=7) with Klebsiella pneumonia; 22.2% (n=2), with Acinetobacter baumannii. Comparison of antibiotic resistance profiles of causative agents with gut colonization results is presented in Table 2.

Conclusion

PCR-tests of rectal swabs for the detection of the major carbapenemase gene families reveal gut colonization with Carba+ at higher frequencies than standard microbiological assay and rectal swab tests on chromogenic agar. Carbapenem resistance of the pathogens causing infectious complications matches more consistently with the PCR-test results.

Keywords

Stem cell transplantation, gut colonization, carbapenem resistance, PCR-test.



Table 1. Comparison of PCR-tests results with data from standard microbiological assay and tests on chromogenic agar

Markovina-tab01.jpg

Table 2. Comparison of antibiotic resistance profiles of causative agents with gut colonization results

Markovina-tab02.jpg
Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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