Assessing Risk of Infectious Episodes in Patients Post Hematopoietic Stem Cell Transplantation Using Pre-Transplant Baseline Colonization Screening
Notice bibliographique
Résumé
INTRODUCTION Infection is a major cause of mortality following hematopoietic stem cell transplant (HCT). The primary source of bacterial infections are gut-derived bacteria from the patient's own microbial flora. Understanding patient specific colonizing organisms may inform downstream infections. This study aims to establish feasibility of identifying baseline colonization of antimicrobial resistant organisms (AROs), such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL), and fluoroquinolone-resistant (FQR) enterobacterales and Clostridioides difficile (C. difficile), to assess the association between pre-transplant colonization and subsequent post-transplant infection. METHODS This prospective cohort study followed 60 HCT patients (34 autologous and 26 allogenic) for 6 months. Primary hematologic diagnoses were multiple myeloma (30%), leukemia (AML, ALL; 27%) and myelodysplastic syndrome (15%). Stool samples were collected pre-transplant and twice weekly for 3 weeks post-transplant. Culture-based stool samples were processed using selective media to detect colonization with AROs harbouring resistance mechanisms and antibiotic class resistance in Gram-negative organisms. C. difficile colonization was assessed using routine glutamine dehydrogenase (GDH) assay and toxin B gene PCR. Clinical data collected included infectious complications, neutropenia, disease relapse, and mortality. Infectious episodes were identified using positive culture results and patients' clinical history, classified by pathogen and ARO type. RESULTS Baseline colonization with C. difficile and/or AROs was identified in 27% (16/60) of patients. The median length of neutropenia was 11 (IQR 7-32) days, with 72% (43/60) of patients developing febrile neutropenia. C. difficile colonization was identified in 10% (6/60) of patients. All colonized patients were asymptomatic at baseline. Ten (17%) patients developed a C. difficile infection (CDI) within 6 months of transplant, with 3 individuals having recurrent CDIs. Of these 10 patients, 50% were amongst those colonized at baseline. Of all colonized patients, 83% (5/6) developed CDI over the course of their follow up period. ARO colonization was found in 18% (11/60) of patients, including VRE (4/11), ESBL and FQRE (4/11), and FQRE alone (3/11). Of the 7 patients colonized with ESBL or FQRE, 1 (14%) patient developed a bloodstream infection with an ESBL K. pneumonaie. An additional 16 (27%) patients were found to be colonized with other Gram-negative organisms, the majority of which harboured inducible beta-lactamases (AMP-C). In the overall cohort, 50% of patients experienced at least 1 culture-positive infection within the first 6 months post-HCT. The majority (45%) of infections were viral in nature. Bloodstream infections accounted for 23% (16/71) of all infections, of which there were 13 episodes of bacteremia amongst 10 participants. Of these, 4/10 participants were diagnosed with resistant Gram-negative bacteremia including 3 with ESBL K. pneumonaie. Furthermore, 2/10 participants were diagnosed with VRE bacteremia. Of the 26 individuals who underwent an allogenic HCT, data pertaining to graft-vs-host disease (GVHD) was available for 23 participants at the 6-month follow-up. Nine (39%) individuals developed GVHD, with most cases presenting as skin GVHD. Among these, there was 1 severe case of gastrointestinal GVHD which resulted in death. Complete 6-month follow-up data regarding disease relapse and mortality was available for 47 of the 60 participants. Six (13%) individuals relapsed within the follow-up period and 4 of the patients underwent further treatment (e.g., chimeric antigen receptor T-cell (CART) therapy, subsequent allogenic HCT). The remaining 2 individuals' relapse resulted in death. In total, there were 6/47 (13%) reported deaths by the 6-month follow-up, including 2 secondary to infection. CONCLUSION This study highlights the significant burden of infections post-HCT and demonstrates the feasibility of establishing pre-transplant baseline colonization to identify resistant organisms that may inform downstream infection risk. Future studies are needed to evaluate use of colonization data for predicting post-transplant infection and assess the role of targeted prophylaxis or treatment based on patient's flora.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».