Rectal colonization with multidrug-resistant organisms in adult acute leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective, longitudinal, single-center study.
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INTRODUCTION: Rectal colonization with multidrug-resistant organisms (MDROs) represents a frequent issue in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) for acute leukemia. However, the prognostic significance of MDRO-colonization in these patients remains debated. METHODS: This retrospective, longitudinal, single-center study included 100 patients with acute myeloid or lymphoblastic leukemia treated at Verona University Hospital from diagnosis to allo-HSCT. MDRO-colonization was monitored by rectal swab at admission and weekly during hospitalization. Colonized patients underwent targeted antibiotic therapy when clinically required. AIM OF THE STUDY: To assess epidemiology, timing, and impact of rectal MDRO-colonization on infection occurrence, infection-related mortality (IRM) within day +100, overall survival (OS), and transplant-related mortality (TRM). RESULTS: Rectal colonization with 44 MDRO strains was detected in 35 (35%) patients undergoing allo-HSCT, either at hospital admission (45.7%) or during hospitalization (54.3%). Enterobacterales accounted for 72.7% of MDROs, with 68.5% of colonizing strains being detected during previous hospital stays for induction or consolidation therapies. MDRO-related bloodstream infections (BSI) occurred in 9 (9%) patients, 7 (77.8%) of whom being rectal carriers. IRM within day +100 was null. OS was significantly lower in MDRO-carriers as compared to non-carriers only at univariate analysis. TRM did not differ significantly between the two groups in both univariate and multivariate analyses. CONCLUSION: Despite the limitations of a single-center retrospective study, our data show that careful monitoring of rectal colonization and prompt use of targeted antibiotics may temper the negative impact of MDRO-related infections in adult acute leukemia patients undergoing allo-HSCT, even in the setting of a higher rate of BSIs.