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 patients colonized with MDR bacteria (primarily carbapenem-resistant klebsiella pneumoniae, KPC), before allo-SCT.We also investigated the feasibility and safety of an antimicrobial de-escalating approach in these patients.Since 2021, 106 patients have been undergoing allo-SCT in our department, and Laminated Tapes 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 the overall de-escalation rate was 79%, with 75% in patients with fever of unknown origin (FUO).Among the cohort of patients with MDR-positive rectal swabs just before allo-SCT (n = 18), the de-escalation rate was 100%.The all-cause mortality rates at 30 and 100 days for the whole MDR patient population were 6% (2/34) and 12% (4/34), respectively.
Day +30 infection-related mortality rate was 3%.In KONJAC RICE 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.