EPIDEMIOLOGICAL FEATURES OF BACTERIAL INFECTIONS IN BONE MARROW TRANSPLANT UNITS

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Abstract

The aim of the study was to identify the epidemiological features of bacterial infections in patients and circulation of epidemiologically significant microorganisms in the bone marrow transplant (BMT) units. Materials and methods. The study was conducted in three BMT departments. To identify the epidemiological features of bacterial infections, a prospective observational study was conducted from 01 April 2014 to 31 August 2014 (91 patients) which included active detection of cases of infection and microbiological examination of patients. In order to detect the circulation of epidemiologically significant microorganisms, point prevalence studies (59 patients, 170 environmental samples) were conducted. To study the role of colonization, microbiological monitoring of patients on admission to the department was carried out, and repeated every week before discharge. Swab samples from skin and mucous membrane of the oral cavity and stool sampleswere included in the monitoring. In total, 639 samples from 50 patients were tested. Results. The study revealed a high incidence of infectious complications in BMT patients (100 cases of bacterial infections in 57 patients: sepsis 30.8 per 100 patients, pneumonia 26.4 per 100 patients, urinary tract infections 32.9 per 100 patients, soft tissue infection 9.9 per 100 patients, catheter-associated bloodstream infection 9.9 per 100 patients). Most infections were caused by Gram-negative bacteria, in particular K. pneumoniae. The onset of disease manifestation was preceded by colonization of the patient with these microorganisms. Fatal outcomes were observed from sepsis and pneumonia caused by K. pneumoniae and/or P. aeruginosa. Sepsis and pneumonia were often associated with cytopenia, RR 2.63 [95% CI 1.52–4.57] p = 0.004 and RR 3.97 [95% CI 2.19–7.19] p < 0.001 respectively. In course of observation, the frequency of colonization of patients with microorganisms susceptible to antibiotics decreased, and colonization with resistant pathogens increased. A series of prevalence studies revealed a constant circulation of VRE in the BMT units with a contacttransmission via household objects. Multidrug-resistant gram-negative microorganisms did not have a constant circulation and appeared sporadically against the background of the constant circulation of susceptible strains of these pathogens. Conclusions. Prospective epidemiological surveillance and microbiological monitoring are required in the BMT units. Widespread contamination of household objects in the environment indicates the need to strengthen the hygienic education of patients and visitors as well as disinfection of these facilities. In addition, we recommend introduction of weekly fecal screening cultures to monitor intestinal colonization of patients with MDRO.

 

About the authors

A. V. Lyubimova

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Email: svetaryahovskih@list.ru
PhD, MD (Medicine), Professor, Department of Epidemiology, Parasitology and Disinfectology Russian Federation

S. A. Ryakhovskikh

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Author for correspondence.
Email: svetaryahovskih@list.ru
PhD Candidate, Department of Epidemiology, Parasitology and Disinfectology Russian Federation

N. A. Shalyapina

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Email: svetaryahovskih@list.ru
PhD Candidate, Department of Epidemiology, Parasitology and Disinfectology Russian Federation

T. V. Brodina

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Email: svetaryahovskih@list.ru
PhD Candidate, Department of Epidemiology, Parasitology and Disinfectology Russian Federation

M. Yu. Averyanova

Institute of Pediatric Hematology and Transplantation named after R.M. Gorbacheva, Pavlov First St. Petersburg State Medical University, St. Petersburg

Email: svetaryahovskih@list.ru
PhD (Medicine), Hematologist Russian Federation

B. I. Aslanov

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Email: svetaryahovskih@list.ru
Associate Professor, Department of Epidemiology, Parasitology and Disinfectology Russian Federation

V. V. Nechaev

North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

Email: svetaryahovskih@list.ru
PhD, MD (Medicine), Professor, Department of Infectious Diseases Russian Federation

References

  1. Войцеховский В.В. Анализ инфекционных осложнений гемобластозов в Амурской области // Бюллетень физиологии и патологии дыхания. 2012. № 46. С. 64–68. [Wojciechowski V.V. Analysis infectious complications of hemoblastoses in the Amur region. Byulleten’ fiziologii i patologii dykhaniya = Bulletin of the Physiology and Pathology Breathing, 2012, no. 46, pp. 64–68. (In Russ.)]
  2. Галстян Г.М., Макарова П.М., Кузьмина Л.А., Паровичникова Е.Н., Клясова Г.А., Покровская О.С., Дроков М.Ю., Новиков В.А., Троицкая В.В., Костина И.Э., Савченко В.Г. Успешная трансплантация аллогенного костного мозга у больных с тяжелым грамотрицательным сепсисом и септическим шоком // Клиническая онкогематология. Фундаментальные исследования и клиническая практика. 2014. Т. 7, № 2. С. 122–130. [Galstyan G.M., Makarova P.M., Kuz’mina L.A., Parovichnikova E.N., Klyasova G.A., Pokrovskaya O.S., Drokov M.Yu., Novikov V.A., Troitskaya V.V., Kostina I.E., Savchenko V.G. Successful allogeneic bone marrow transplantation in patients with severe gram-negative sepsis and septic shock. Klinicheskaya onkogematologiya. Fundamental’nye issledovaniya i klinicheskaya praktika = Clinical Oncohematology. Basic Research and Clinical Practice, 2014, vol. 7, no. 2, pp. 122–130. (In Russ.)]
  3. Гельфанд Б.Р., Белоцерковский Б.З., Проценко Д.Н., Яковлев С.В., Еремин С.Р., Руднов В.А., Белобородов В.Б., Сидоренко С.В., Ефименко Н.А., Романовский Ю.Я. Нозокомиальная пневмония в хирургии (М етодические рекомендации) // Инфекции и антимикробная терапия. 2003. Т. 5, № 6. С. 124–129. [Gelfand B.R., Belotserkovsky B.Z., Protsenko D.N., Yakovlev S.V., Eremin S.R., Rudnov V.A., Beloborodov V.B., Sidorenko S.V., Efimenko N.A., Romanovsky Yu.Ya. Nosocomial pneumonia in surgery (Guidelines). Infektsii i antimikrobnaya terapiya = Infections and Antimicrobial Therapy, 2003, no. 5–6, pp. 124–129. (In Russ.)]
  4. Клясова Г.А., Капорская Т.С., Сперанская Л.Л., Поспелова Т.И., Миронова А.В., Масчан М.А., Верещагина С.А., Крайнова Л.Е., Трушина Е.Е., Фролова И.Н., Юрицина Н.Ю. Возбудители сепсиса у иммунокомпрометированных больных: структура и проблемы антибиотикорезистентности (результаты многоцентрового исследования) // Гематология и трансфузиология. 2007. № 1. С. 11–19. [Klyasova G.A., Kaporskaya T.S., Speranskaya L.L., Pospelova T.I., Miro-nova A.V., Maschan M.A., Vereshchagina S.A., Krainova L.E., Trushina E.E., Frolova I.N., Yuricina N.Yu. The causative agents of sepsis in immunocompromised patients: structure and problems of antibiotic resistance (results of a multicenter study). Gematologiya i transfuziologiya = Hematology and Blood Transfusion, 2007, no. 1, pp. 11–19 (In Russ.)]
  5. Птушкин В.В., Волкова М.А. Современные возможности лечения фебрильной нейтропении // Русский медицинский журнал. 1998. № 22. С. 1439–1446. [Ptushkin V.V., Volkova M.A. Current treatment options of febrile neutropenia. Russkii meditsinskii zhurnal = Russian Medical Journal, 1998, no. 22, pp. 1439–1446 (In Russ.)]
  6. Сепсис в начале XXI века. Классификация. Клинико-диагностическая концепция и лечение. Патолого-анатомическая диагностика: практическое руководство. Под ред. В.С. Савельева, Б.Р. Гельфанда. М.: Литтерра, 2006. 176 c. [Sepsis v nachale XXI veka. Klassifikatsiya. Kliniko-diagnosticheskaya kontseptsiya i lechenie. Patologo-anatomicheskaya diagnostika: prakticheskoe rukovodstvo. Pod red. V.S. Savel’eva, B.R. Gel’fanda [Sepsis in the beginning of the XXI century. Classification. Clinical and diagnostic concept and treatment. Post-mortem diagnosis. A practical guide. Eds. Savelyev V.S., Gelfand B.R.]. Moscow: Litterra, 2006. 176 p.
  7. Сидоренко С.В. Инфекции, связанные с центральным венозным катетером // Инфекции и антимикробная терапия. 2001. № 2. С. 24–35. [Sidorenko S.V. Infections associated with central venous catheter. Infektsii i antimikrobnaya terapiya = Infections and Antimicrobial Therapy, 2001, no. 2, pp. 24–35. (In Russ.)]
  8. Соломенный А.И., Максимов А.Ю., Саралов А.И., Яфаев Р.Х., Гончаров А.Е., Керопиан Е.А., Мултых И.Г. Появление интегрон-позитивного полирезистентного штамма Acinetobacter baumannii в российских стационарах // Журнал микробиологии, эпидемиологии и иммунобиологии. 2008. № 4. С. 89–91. [Solomennyy A.P., Maksimov A.Yu., Saralov A.I., Yafayev R.Kh., Goncharov A.E., Keropian E.A., Multyh I.G. The appearance of integron-positive strains of multidrug-resistant Acinetobacter baumannii in Russian hospitals. Zhurnal mikrobiologii, epidemiologii i immunobiologii = Journal of Microbiology, Epidemiology and Immunobiology, 2008, no. 4, pp. 89–91. (In Russ.)]
  9. Чучалин А.Г., Генфальд Б.Р. Нозокомиальная пневмония взрослых (Национальные рекомендации) // Клиническая микробиология и антимикробная химиотерапия. 2009. Т. 11, № 2. С. 100–142. [Chuchalin A.G., Genfald B.R. Nosocomial pneumonia of adults (National guidelines). Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy, 2009, vol. 11, no. 2, pp. 100–142. (In Russ.)]
  10. Чучалин А.Г., Синопальников А.И., Козлов Р.С., Тюрин И.Е., Рачина С.А. Нозокомиальная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. Пособие для врачей // Пульмонология. 2005. № 3. С. 13–36. [Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Tyurin I.E., Rachina S.A. Nosocomial pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. A guide for physicians. Pul’monologiya = Pulmonology, 2005, no. 3, pp. 13–36. (In Russ.)]
  11. Bass P., Karki S., Rhodes D., Gonelli S., Land G., Watson K., Spelman D., Harrington G., Kennon J., Cheng A.C. Impact of chlorhexidine-impregnated washcloths on reducing incidence of vancomycin-resistant enterococci colonization in hematology-oncology patients. Am. J. Infect. Control, 2013, vol. 41, no. 4, pp. 345–348. doi: 10.1016/j.ajic
  12. Dykewicz C. A., Harold W. J., Kaplan J.E. CDC Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Biology of Blood and Marrow Transplantation, 2000, no. 6, pp. 659–734. doi: 10.1016/j.bbmt.2009.06.019
  13. Dutka-Malen S., Evers S., Courvalin P. Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR. J. Clin. Microbio.l, 1995, vol. 33, no. 1, pp. 24–27.
  14. Girmenia C., Rossolini G.M., Piciocchi A., Bertaina A., Pisapia G., Pastore D., Sica S., Severino A., Cudillo L., Ciceri F., Scimè R., Lombardini L., Viscoli C., Rambaldi A.; Gruppo Italiano Trapianto Midollo Osseo (GITMO). Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: a nationwide retrospective survey from Italy. Bone Marrow Transplant., 2015, vol. 50, no.2, pp. 282–288. doi: 10.1038/bmt.2014.231
  15. Levy M.M., Fink M.P., Marshall J.C., Abraham E., Angus D., Cook D., Cohen J., Opal S.M., Vincent J.L., Ramsay G. International sepsis definitions conference. Crit. Care Med., 2003, vol. 31, no. 4, pp. 1250–1256. doi: 10.1007/s00134-003-1662-x
  16. Mermel L.A., Farr B.M., Sherertz R.J., Raad I.I., O’Grady N., Harris J.S., Craven D.E.; Infectious Diseases Society of America; American College of Critical Care Medicine; Society for Healthcare Epidemiology of America. Guidelines for the management of in travascular catheter-related infections. Clin. Infect. Dis., 2001, vol. 32, no. 9, pp. 1249–1272. doi: 10.1086/320001
  17. Mikulska M., Del Bono V., Viscoli C. Bacterial infections in hematopoietic stem cell transplantation recipients. Curr. Opin. Hematol., 2014, vol. 21, no. 6, pp. 451–458. doi: 10.4084/MJHID.2015.045
  18. Martin B., Garriga M., Hugas M., Aymerich T. Genetic diversity and safety aspects of enterococci from slightly fermented sausages. J. Appl. Microbiol., 2005, vol. 98, no. 5, pp. 1177–1190. doi: 10.1111/j.1365-2672.2005.02555.x
  19. Ruhnke M., Arnold R., Gastmeier P. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. Lancet Oncol., 2014, vol. 15, no. 13, pp. 606–619. doi: http://dx.doi.org/10.1016/s1470-2045(14)70344-4
  20. Seifert H., Jansen B., Widmer A.F., Farr B.M. Central-venous catheters // Catheter-related infections. Eds. Seifert H., Jansen B., Farr B.M. 2nd ed. New York: Marcel Dekker, 2004, pp. 293–315. doi: 10.1007/s00134-003-2045-z
  21. Srigley J.A., Furness C.D., Gardam M. Measurement of patient hand hygiene in multiorgan transplant units using a novel technology: an observational study. Infect. Control Hosp. Epidemiol., 2014, vol. 35, no. 11, pp. 1336–1341. doi: 10.1086/678419
  22. Top J., Schouls L.M., Bonten M.J.M., Willems R.J.L. Multiple-locus variable-number tandem repeat analysis, a novel typing scheme to study the genetic relatedness and epidemiology of Enterococcus faecium isolates. J. Clin. Microbiol., 2004, vol. 42, no. 10, pp. 4503–4511. doi: 10.1128/jcm.42.10.4503–4511.2004
  23. Tsiatis A.C., Manes B., Calder C., Billheimer D., Wilkerson K.S., Frangoul H. Incidence and clinical complications of vancomycin-resistant enterococcus in pediatric stem cell transplant patients. Bone Marrow Transplant., 2004, vol. 33, no. 9, pp. 937–941. doi: 10.1038/sj.bmt.1704462
  24. Vincent J.L., de Backer D.; SCCM. International Sepsis Forum. The International Sepsis Forum’s controversies in sepsis: my initial vasopressor agent in septic shock is dopamine rather than norepinephrine. Crit. Care, 2003, vol. 7, no. 1, pp. 6–8. doi: 10.1186/ cc1851
  25. Zirakzadeh A., Gastineau D.A., Mandrekar J.N., Burke J.P., Johnston P.B., Patel R. Vancomycin-resistant enterococcal colonization appears associated with increased mortality among allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant., 2008, vol. 41, no. 4, pp. 385–392. doi: 10.1038/sj.bmt.170591

Copyright (c) 2018 Lyubimova A.V., Ryakhovskikh S.A., Shalyapina N.A., Brodina T.V., Averyanova M.Y., Aslanov B.I., Nechaev V.V.

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