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Infection control management and surveillance of carbapenem-resistant Gram-negative bacteria in hematopoietic stem cell recipients

机译:造血干细胞受体对耐碳青霉烯类革兰氏阴性菌的感染控制管理和监测

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摘要

Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for selected diseases of the hematopoietic system. In the context of HSCT, bloodstream infections caused by Gram-negative bacteria (GNB) significantly contribute to morbidity and mortality. Antibiotic treatment of bloodstream infections with carbapenem-resistant (CR) GNB presents a particular challenge. As a part of our infection control management, the admission of a patient who was known to be colonized with a CR Acinetobacter baumannii triggered an active weekly screening of all patients to determine the prevalence and potential transmission of CR GNB and CR Acinetobacter baumannii in particular. Over a 3 month period a total of 71 patients were regularly screened for colonization with CR GNB. Including the index patient, a total of three patients showed CR GNB colonization representing a prevalence of 4.2%. Nosocomial transmission of CR Acinetobacter baumannii or other CR GNB was not observed. However, the index patient developed a subsequent bloodstream infection with the CR Acinetobacter baumannii, therefore empiric antibiotic therapy based on the known resistance profile was initiated. A weekly prevalence screening for CR GNB might be an effective monitoring tool for potential transmission, may enhance existing infection control management concepts and may support the decision making for empiric antibiotic therapy.
机译:造血干细胞移植(HSCT)是针对造血系统某些疾病的治疗选择。在HSCT的背景下,革兰氏阴性菌(GNB)引起的血流感染显着增加了发病率和死亡率。耐碳青霉烯(CR)GNB对血液感染的抗生素治疗面临着特殊挑战。作为我们感染控制管理的一部分,一名已知患有鲍曼不动杆菌的患者的入院触发了对所有患者的每周一次积极筛查,以确定特别是CR GNB和鲍曼不动杆菌的患病率和潜在传播。在3个月的时间内,共有71例患者接受了CR GNB的定期定居筛选。包括索引患者在内,共有3例患者出现CR GNB菌落,占4.2%的患病率。未观察到CR鲍曼不动杆菌或其他CR GNB的医院内传播。然而,该索引患者随后发生了鲍曼不动杆菌的血液感染,因此开始了基于已知耐药性的经验性抗生素治疗。每周一次的CR GNB患病率筛查可能是潜在传播的有效监测工具,可以增强现有的感染控制管理理念,并可以支持经验性抗生素治疗的决策。

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