Colonization by Extended-Spectrum β-Lactamase-Producing Enterobacterales and Bacteremia in Hematopoietic Stem Cell Transplant Recipients

• Published in: Antibiotics (Basel) 2024-05, Vol.13 (5), p.448
• Main Authors: Gonçalves, Luiza Arcas, Anjos, Beatriz Barbosa, Tavares, Bruno Melo, Marchi, Ana Paula, Côrtes, Marina Farrel, Higashino, Hermes Ryoiti, de Carvalho Moraes, Bruna Del Guerra, Bampi, José Victor Bortolotto, Pinheiro, Liliane Dantas, Spadao, Fernanda de Souza, Rocha, Vanderson, Guimarães, Thais, Costa, Silvia Figueiredo
• Format: Article
• Language: English
• Subjects: Bacteremia; Beta lactamases; bloodstream infection; Cephalosporins; Colonization; E coli; Electrophoresis; Empirical analysis; Enterobacterales; extended-spectrum β-lactamase-producing Enterobacterales; Gene sequencing; Genes; Genomes; Health aspects; hematopoietic stem cell transplant; Hematopoietic stem cells; Infection; Leukemia; Lymphoma; Medical research; Medicine, Experimental; Mortality; Multidrug resistance; Multiple myeloma; Patients; Population studies; Pulsed-field gel electrophoresis; Risk assessment; Risk factors; Selective media; Stem cell transplantation; Stem cells; Transplantation; Transplants; Transplants & implants; Urinary tract infections; Whole genome sequencing; β Lactamase
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics13050448

Assessing the risk of multidrug-resistant colonization and infections is pivotal for optimizing empirical therapy in hematopoietic stem cell transplants (HSCTs). Limited data exist on extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) colonization in this population. This study aimed to assess whether ESBL-E colonization constitutes a risk factor for ESBL-E bloodstream infection (BSI) and to evaluate ESBL-E colonization in HSCT recipients. A retrospective analysis of ESBL-E colonization and BSI in HSCT patients was conducted from August 2019 to June 2022. Weekly swabs were collected and cultured on chromogenic selective media, with PCR identifying the β-lactamase genes. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) assessed the colonizing strains' similarities. Of 222 evaluated HSCT patients, 59.45% were colonized by ESBL-E, with 48.4% at admission. The predominant β-lactamase genes were (52%) and (20%). PFGE analysis did not reveal predominant clusters in 26 and 15 strains. WGS identified ST16 and ST11 as the predominant sequence types among . Thirty-three patients developed thirty-five Enterobacterales-BSIs, with nine being third-generation cephalosporin-resistant. No association was found between ESBL-E colonization and ESBL-BSI ( = 0.087). Although the patients presented a high colonization rate of ESBL-E upon admission, no association between colonization and infection were found. Thus, it seems that ESBL screening is not a useful strategy to assess risk factors and guide therapy for ESBL-BSI in HSCT-patients.