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ORIGINAL RESEARCH article

Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
Volume 15 - 2024 | doi: 10.3389/fmicb.2024.1487617
This article is part of the Research Topic Multidrug Resistant Gram-negative Bacteria in Fragile Host View all 3 articles

The antibiotic de-escalation strategy in patients colonized by multidrug-resistant bacteria after allogeneic stem cell transplantation

Provisionally accepted
Roberto Bono Roberto Bono 1Giuseppe Sapienza Giuseppe Sapienza 1Stefania Tringali Stefania Tringali 1Cristina Rotolo Cristina Rotolo 1*Alessandra Santoro Alessandra Santoro 1*Laura Di Noto Laura Di Noto 1*Angelo Pirrera Angelo Pirrera 2*Floriana Schirò Floriana Schirò 2*Raffaella Rubino Raffaella Rubino 3*Antonio Cascio Antonio Cascio 3*Sergio Siragusa Sergio Siragusa 2*Carmen Tomaselli Carmen Tomaselli 4*Orazia Diquattro Orazia Diquattro 1*Caterina Patti Caterina Patti 1*Luca Castagna Luca Castagna 1*
  • 1 Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
  • 2 Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Palermo, Italy
  • 3 Department PROMISE-Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone",, Palermo, Italy
  • 4 Hematology Department ARNAS Civico Di Cristina, Palermo, Italy

The final, formatted version of the article will be published soon.

    Colonization by multidrug-resistant (MDR) bacteria and related bloodstream infections (BSI) are associated with a high rate of mortality in patients with hematological malignancies after intensive chemotherapy and allogeneic stem cell transplantation (allo-SCT).In this retrospective study, we analyzed the outcomes of MDR-colonized (mostly by carbapenem resistant klebsiella pneumoniae, KPC) patients before allo-SCT and investigated the feasibility and safety for antimicrobial de-escalating approach in such patients. Since 2021, 106 patients have been undergoing allo-SCT in our department and 34 (32%) of them were colonized by MDR bacteria before allo-SCT. In the pre-engraftment period, 84% received an empiric antibiotic therapy (EAT) active against MDR bacteria and 16% were treated with a conventional EAT. The MDR translocation rate was null and overall, overall the de-escalation rate was 79%, and 75% in patients with fever of unknown origin (FUO). Looking at the cohort of patients with MDR positive rectal swab just before allo-SCT (n= 18), the de-escalation rate was 100%. The all-cause mortality at 30 and 100 days for the whole MDR patient population were 6% (2/34) and 12% (4/34), respectively. Day +30 infection-related infection mortality rate was 3%.In this study, we confirm the safety of the de-escalation approach in patients with previous MDR infection after allo-SCT. This could reduce the exposure time to EAT antibiotics, reducing the selective pressure.

    Keywords: MDR - (multi drug resistant), Allogeneic stem cell transplanation, De-escalation antibiotic therapy, stool colonisation, Empiric antibiotic therapy

    Received: 28 Aug 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Bono, Sapienza, Tringali, Rotolo, Santoro, Di Noto, Pirrera, Schirò, Rubino, Cascio, Siragusa, Tomaselli, Diquattro, Patti and Castagna. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Cristina Rotolo, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
    Alessandra Santoro, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
    Laura Di Noto, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
    Angelo Pirrera, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Palermo, Italy
    Floriana Schirò, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Palermo, Italy
    Raffaella Rubino, Department PROMISE-Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone",, Palermo, Italy
    Antonio Cascio, Department PROMISE-Infectious and Tropical Diseases Unit, AOU Policlinico "P. Giaccone",, Palermo, Italy
    Sergio Siragusa, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", Palermo, Italy
    Carmen Tomaselli, Hematology Department ARNAS Civico Di Cristina, Palermo, Italy
    Orazia Diquattro, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
    Caterina Patti, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
    Luca Castagna, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy

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