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Multidrug‐resistant Enterobacteriaceae, P seudomonas aeruginosa , and vancomycin‐resistant Enterococcus : Three major threats to hematopoietic stem cell transplant recipients
Author(s) -
Satlin Michael J.,
Walsh Thomas J.
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12762
Subject(s) - medicine , carbapenem resistant enterobacteriaceae , antimicrobial stewardship , enterococcus , population , antimicrobial , daptomycin , microbiology and biotechnology , intensive care medicine , klebsiella pneumoniae , antibiotic resistance , vancomycin , antibiotics , staphylococcus aureus , biology , bacteria , environmental health , escherichia coli , gene , biochemistry , genetics
Hematopoietic stem cell transplant ( HSCT ) recipients are uniquely threatened by the emergence of multidrug‐resistant ( MDR ) bacteria because these patients rely on immediate active antimicrobial therapy to combat bacterial infections. This review describes the epidemiology and treatment considerations for three challenging MDR bacterial pathogens in HSCT recipients: MDR Enterobacteriaceae, including extended‐spectrum β‐lactamase ( ESBL )‐producing and carbapenem‐resistant Enterobacteriaceae ( CRE ), P seudomonas aeruginosa , and vancomycin‐resistant Enterococcus ( VRE ). These bacteria are common causes of infection in this population and bacteremias caused by these organisms are associated with high mortality rates. Carbapenems remain the treatments of choice for serious infections due to ESBL ‐producing Enterobacteriaceae in HSCT recipients. Administration of β‐lactam agents as an extended infusion is associated with improved outcomes in patients with severe infections caused by P . aeruginosa . Older agents used for the treatment of CRE and MDR P . aeruginosa infections, such as polymyxins and aminoglycosides, have major limitations. Newer agents, such as ceftazidime‐avibactam and ceftolozane‐tazobactam have great potential for the treatment of K lebsiella pneumoniae carbapemenase‐producing CRE and MDR P . aeruginosa , respectively, but more pre‐clinical and clinical data are needed to better evaluate their efficacy. Daptomycin dosages ≥8 mg/kg/day are recommended to treat VRE infections in this population, particularly in the setting of increasing daptomycin resistance. Strategies to prevent these infections include strict adherence to recommended infection control practices and multidisciplinary antimicrobial stewardship. Last, gastrointestinal screening to guide empirical therapy and the use of polymerase chain reaction‐based rapid diagnostics may decrease the time to administration of appropriate therapy for these infections, thereby leading to improved outcomes.