Methods: All patients who underwent an autologous or allograft stem cell transplant (SCT) between Sept-15 and Dec-17 at a large tertiary hospital who were CPE positive on routine rectal screening were reviewed. Length of stay (LoS) post SCT, including readmissions for sepsis and number of days of antibiotics therapy were assessed. Controls were matched for time and type of SCT in a 3 controls to 1 case ratio. T-test was performed to analyse differences between groups (statistical significance attributed when p<0.05).
Results: The case sample had 20 SCT CPE positive patients, of which allograft (n=9) and autograft (n=11). The control sample was made up of 59 SCT CPE negative patients, allograft (n=27) and autograft (n=32). All patients had antibiotic therapy post SCT.
Average LoS for the case sample was significantly longer in the autograft group (41.7 vs. 23.6 days, case versus control, p=0.01), but not significant in the allograft group (75.1 vs. 58 days, p=0.12).
Both autograft and allograft case samples had significantly longer duration of meropenem therapy, 24.8 vs. 14.4 days for allograft (p=0.03) and 9.4 vs. 5.5 days for autograft (p=0.03), cases versus control. Colistin therapy was longer in both case samples (p=0.03 in autograft and p=0.006 in allograft). Tigecycline therapy was significantly longer in the autograft case versus control sample (p=0.006), with teicoplanin and piperacillin-tazobactam therapy significantly longer in the autograft case versus control sample, p=0.015 and p=0.03 respectively.
Conclusion: The LoS post SCT and duration of antibiotic therapy were found to be key proxy measures of worsening outcomes for CPE positive patients versus CPE negative patients who had undergone SCT. Although reasons for CPE colonization vary, there appears to be an overall negative impact on patient outcomes and increased use of more toxic agents, demonstrating the need for early directed CPE decontamination therapy of these at-risk patients, such as use of Faecal Microbiota Transplant (FMT).
B. Mullish, None
M. Thursz, None
J. Marchesi, None
J. Pavlu, None
F. Davies, None
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