Bacteraemia is a common and one of the serious complications in haematopoietic stem cell transplantation (HSCT). To date, there are no published data on antibiotic resistance and clinical outcome among HSCT recipients in Malaysia. The aims of the present study was to analyse the prevalence, antibiotic resistance and clinical outcome of bacteraemia in HSCT recipients within 100 days following transplantation. We retrospectively analysed the prevalence, antibiotic resistance pattern and mortality rate of early bacteraemia among HSCT recipients in a single centre over a 5-year period (2013-2017). Thirty patients of 85 HSCT recipients developed bacteraemia with 40 positive cultures resulting in prevalence of 47% (40/85). Gram negative bacteria (GNB) accounted for 60.5% of total isolates. Enterobacteriaceae and Coagulase negative Staphylococcus (CoNS) were the commonest pathogens isolated. GNB showed a high resistance rate to ciprofloxacin. Only 30% of recipients responded to first line empirical antibiotics for febrile neutropenia (FN). The mortality rate was 13.3% (4/30), of which 50% was attributed to multi-drug resistance (MDR) Acinetobacter and 25% to extended spectrum beta-lactamase (ESBL) Enterobacteriaceae. Bacteraemia is a frequent and life-threatening early complication among HSCT recipients with MDR GNB being the commonest cause of mortality. The high rate of resistance to ciprofloxacin and failure of the first line empirical antibiotics to treat FN calls for a thorough evaluation of the current antibiotic prophylaxis and empirical treatment protocols. These findings have important clinical implications regarding the use and selection of both prophylactic and empiric antibiotic regimens to treat FN.
Bacteraemia in Haematopoietic Stem Cell Transplant Recipients in a Single Tertiary Referral Centre
Abstrak
Bakteremia merupakan salah satu komplikasi yang kerap dan serius dalam transplantasi sel stem hematopoietik (HSCT). Sehingga kini, tiada data yang diterbitkan mengenai kerentanan antibiotik dan kesudahan klinikal di kalangan penerima HSCT di Malaysia. Matlamat kajian ini adalah untuk menganalisis kekerapan, kerentanan antibiotik dan kesudahan klinikal akibat bakteremia yang dihidapi oleh penerima HSCT dalam tempoh 100 hari selepas transplantasi. Kami secara retrospektif menganalisa kadar kekerapan, pola kerentanan antibiotik dan kadar kematian dikalangan penerima HSCT di satu pusat perubatan selama tempoh 5 tahun (2013-2017). Tiga puluh daripada 85 penerima HSCT menghidapi bakteremia dengan 40 kultur positif, menghasilkan kadar kekerapan bakteremia sebanyak 47% (40/85). Gram negatif bakteria (GNB) menyumbang kepada 60.5% daripada jumlah pencilan. Enterobacteriaceae dan Coagulase negatif Staphylococcus (CoNS) adalah patogen yang paling kerap ditemui. GNB menunjukkan kadar kerentanan antibiotik sangat tinggi terhadap ciprofloxacin. Antibiotik empirikal pilihan pertama hanya berkesan terhadap 30% penerima yang menghidap demam neutropenia (DN). Kadar kematian disebabkan oleh bakteremia adalah 13.3% (4/30), di mana 50% disebabkan oleh kerentanan pelbagai antibiotik (MDR) Acinetobacter dan 25% extended spectrum beta-lactamase (ESBL) Enterobacteriaceae. Bakteremia merupakan komplikasi awal yang kerap dan mengancam nyawa di kalangan penerima HSCT di mana MDR GNB merupakan penyebab utama kematian. Kadar kerentanan yang tinggi kepada ciprofloxacin dan kegagalan antibiotik empirikal pilihan pertama untuk merawat DN memerlukan penilaian menyeluruh kepada protokol antibiotik pencegahan dan rawatan empirikal yang sedia ada. Penemuan ini mempunyai implikasi klinikal yang penting mengenai penggunaan dan pemilihan kedua-dua rejimen antibiotik profilaktik dan empiric untuk merawat DN.
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