Multidrug resistant bacteremia in hematopoietic stem cell transplant recipients.

BACKGROUND: Bacteremia become fearsome in hematopoietic stem cell transplant (HSCT) recipients with the emergence of multidrug-resistant (MDR) strains. AIM: Our purpose was to investigate the prevalence of MDR bacteremia in HSCT recipients at the Tunisian National Bone Marrow Transplant Center, associated factors and attributable mortality rate. METHODS: Our retrospective study (January 2010-December 2017) included all MDR bacteremia in the Hematology department. MDR rods were: extended spectrum beta-lactamase producing Enterobacterales (ESBL-E), P. aeruginosa and A. baumannii resistant to at least three families of antibiotics, methicillin-resistant S. aureus (MRSA) and vancomycin resistant E. faecium (VRE). RESULTS: The prevalence of MDR bacteremia among HSCT recipients was 5.9% (48/816) with a stable trend over time (rs=0.18). Neutropenia, prior hospitalization, prior antibiotherapy and prior colonization with MDR pathogens were observed in 59%, 58%, 48% and 31% of cases, respectively. Imipenem was the most prescribed first-line antibiotic (50%). The attributable mortality rate was 13%. MDR bacteria (n=48) belonged to ESBL-E (60%), P. aeruginosa (19%), A. baumannii (13%), MRSA (4%) and VRE (4%). For ESBL-E and P. aeruginosa, the rates of antibiotic resistance were respectively, 17% and 44% to imipenem, 31% and 56% to amikacin and 15% and 0% to colistin. Strains of A. baumannii were susceptible only to colistin. The MRSA (n=2) were resistant to ciprofloxacin and gentamicin and susceptible to glycopeptides. The VRE (n=2) were susceptible to linezolid and tigecycline. CONCLUSION: Low prevalence of MDR bacteremia in HSCT recipients but high attributable mortality rate, requiring reinforcement of hygiene measures.

Prevalence of healthcare-associated infections at a Tunisian onco-hematology ward.

INTRODUCTION: Healthcare-associated infections (HAIs) are with high rates of mortality and an additional cost, in onco-hematology patients. AIM: To assess the prevalence trends of HAIs in the onco-hematology ward of the Tunisian National Bone Marrow Transplant Center (NBMTC), and to determine the principal associated risk factors. METHODS: Six repeated point prevalence surveys were conducted, from May 2018 to March 2019, using a two months interval. All patients hospitalized in the day of the survey were included. Risk factors of HAIs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). They were assessed using a logistic regression model. RESULTS: Nineteen patients out of a total of 74 patients have been diagnosed with 19 HAIs, representing a prevalence of 25.7%. No significant downward or upward trend of prevalence was revealed over time (p=0.3). The most common HAI was respiratory tract infection (57.9%) with a prevalence of 14.9%. Multiple logistic regression analysis revealed that HAI was significantly associated with neutropenia (Adjusted OR: 14; 95% CI: 1.5-127; p=0.01) and duration of central venous catheter (Adjusted OR: 1.1; 95% CI: 1-1.2; p=0.005). CONCLUSION: High prevalence of HAIs in our center with a high rate of mortality, requiring identifying potential problems in infection control practices.

Molecular profile of carbapenemase-producing Enterobacterales in burn patients.

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) present a threat to public health worldwide. AIM: To study their prevalence at the Trauma and Burn Center's Burn Unit and investigate their molecular characteristics and their associated antibiotics resistance patterns. METHODS: This is a retrospective study conducted at the Trauma and Burn Center's laboratory between july 2017 and december 2018. It included all patients hospitalized in the Trauma and Burn Center's Burn Unit infected with Enterobacterales resistant to carbapenems. The search of the carbapenemases genes was performed by PCR amplification GeneXpert® IV (Cepheid, Sunnyvale, CA, USA) by Xpert® Carba-R kit. RESULTS: During the study period, among 574 Enterobacterales, 64 strains (11.1%) were resistant to carbapenems, 58 strains (90.6%) of which were CPE. K. pneumoniae was the most predominant bacteria (n=50) fllowed by E. cloacae (n=7), P. mirabilis (n=3), E. aerogenes (n=2), E. coli (n=1) and P. rettgeri (n=1). The most common carbapenemase gene was blaNDM gene (58.6%) followed by blaOXA48 (24.1%). The co-existence of these two genes was identified in ten strains (17.3%). For the 58 CPE, resistance to ertapenem, imipenem and meropenem was 100%, 18.4% and 36.2%, respectively. The highest resistance rates were found to third-generation-cephalosporins (100%), ciprofloxacin (95%) and gentamicin (89.7%). Fosfomycin and colistin had the best susceptibility in vitro with only 5.2% and 4.8% of resistance, respectively. CONCLUSION: The high prevalence of CPE in our center requires continued screening and reinforcement of hygiene measures.