Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation

Abstract

Noha A Kamel,1 Mahmoud S Abdalla,2 Amer Al Ali,3 Mohammad Y Alshahrani,4 Khaled M Aboshanab,5,6 Mervat I El Borhamy1,7 1Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt; 2Hematology and Bone Marrow Transportation (BMT) Unit, International Medical Center (IMC), Cairo, Egypt; 3Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia; 4Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 9088, Saudi Arabia; 5Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt; 6Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, University Technology MARA (Uitm), Campus Puncak Alam, Bandar Puncak Alam, Selangor, 42300, Malaysia; 7International Medical Center, Clinical Microbiology Laboratory, Cairo, EgyptCorrespondence: Khaled M Aboshanab, Tel [phone], Fax [phone], Email [email protected]; [email protected]: Owing to the rising incidence of multidrug-resistant organisms (MDRO) and the high mortality rates associated with such bacterial infections post-hematopoietic stem cell transplantation (HSCT), we investigated the MDRO colonization rate prior to transplantation using an active surveillance approach and determined its impact on subsequent infection during the pre-engraftment period.Methods: A single-center observational study was conducted, and surveillance cultures from multiple body sites, including the rectum, nasal cavity, and groin, were performed at admission to determine MDRO colonization. Serological tests were used to detect certain viruses and toxoplasmosis before HSCT.Results: In the pre-transplant setting, 59 MDRO were recovered from the 40 HSCT recipients. Of the 59 isolates recovered from one or more body sites, 29 were positive for methicillin-resistant Staphylococcus aureus (MRSA), 7 for carbapenem-resistant Enterobacterales (CRE), and 23 were positive for extended-spectrum β-lactamase (ESBLs). Serological assessment before HSCT revealed active or reactivation of latent infection with cytomegalovirus (7.5%), Epstein–Barr virus (EBV; 5%), and Toxoplasma gondii (2.5%) among HSCT patients. In terms of factors associated with pre-engraftment infections, the type of transplant (p=0.04) was statistically significant, whereas other factors, such as age, sex, and underlying conditions, were not. In post-transplant settings, bloodstream infections (BSIs) were documented in 2 allogeneic HSCT patients (5%), and the isolated microorganisms were ESBL-producing E. coli and non-MDR Acinetobacter baumannii.Conclusion: Active screening cultures are a helpful tool for identifying patients colonized by MDRO or relevant viruses before HSCT, and for predicting those at risk of developing subsequent pre-engraftment infections. Additionally, active screening may aid in predicting those who are likely to develop subsequent pre-engraftment infections Our findings highlight the importance of pre-transplant screening for high-priority multidrug-resistant pathogens and the application of infection control interventions after HSCT.Keywords: pre-transplant screening, MRSA, ESBLs, CRE, pre-engraftment infections

Keywords

• pre-transplant screening
• mrsa
• esbls
• cre
• pre-engraftment infections