Infection and Drug Resistance (Oct 2023)

Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization and the Effect on Clinical Outcomes and Prognosis in Allogeneic Hematopoietic Stem Cell Transplanted Patients

  • Wu WQ,
  • Zhang YQ,
  • Xu J,
  • Tang ZX,
  • Li SJ,
  • Wei XY,
  • Li L,
  • Wu HQ,
  • Ma X,
  • Liu JS,
  • Wu DP,
  • Wu XJ

Journal volume & issue
Vol. Volume 16
pp. 6821 – 6831

Abstract

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Wen-Qi Wu,1– 3,* Yu-Qi Zhang,1– 3,* Jie Xu,1– 3,* Zai-Xiang Tang,4 Shi-Jia Li,1– 3 Xi-Ya Wei,1– 3 Ling Li,1– 3 He-Qing Wu,1– 3 Xiao Ma,1– 3 Ji-Sheng Liu,1,5 De-Pei Wu,1– 3 Xiao-Jin Wu1– 3 1Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China; 2National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, People’s Republic of China; 3Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, People’s Republic of China; 4Department of Epidemiology and Statistics, School of Public Health, Faculty of Medicine, Soochow University, Suzhou, People’s Republic of China; 5Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiao-Jin Wu; De-Pei Wu, Email [email protected]; [email protected]: The current study assesses which are the main risk factors, clinical outcome and prognosis following the colonization of CRE in patients that underwent allo-HSCT.Patients and Methods: A total of 343 patients subjected to allo-HSCT in the period comprised between June 2021 and June 2022 were enrolled in this retrospective study. The CRE colonization was diagnosed by clinical history and routine microbial culture of perirectal swab. In this regard, a clinical prediction model was designed based on independent risk factors underlying the pre-transplantation CRE colonization using a backward stepwise logistic regression, followed by the evaluation of its discrimination and calibration efficacies, along with clinical usefulness. Furthermore, univariate and multivariate Cox regression analyses were then conducted to assess the risk factors for post-transplantation clinical outcomes.Results: Out of 343 patients enrolled in this study, 135 (39.3%) reported CRE colonization. The independent risk factor variables for CRE colonization were incorporated into the nomogram to build a prediction model, which showed an area under the curve of 0.767 (95% CI: 0.716– 0.818), and well-fitted calibration curves (χ 2 = 1.737, P = 0.9788). The patients with CRE colonization reported a significantly lower platelet engraftment rate with a higher risk of post-transplantation BSI when compared with the non-CRE colonization group (P = 0.02 and P < 0.001; respectively). The non-relapse mortality (NRM) value was higher in the CRE patients (P < 0.05), consistently with a survival probability that was thus significantly lower for the same timeframe (P < 0.05).Conclusion: A reliable clinical prediction model for pre-transplantation CRE colonization was developed that demonstrated that the CRE colonization negatively affects platelet engraftment and survival outcomes following allo-HSCT.Keywords: CRE, Enterobacteriaceae colonization, perirectal swab, allo-HSCT, risk factors, prognosis

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