Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization and the Effect on Clinical Outcomes and Prognosis in Allogeneic Hematopoietic Stem Cell Transplanted Patients

Abstract

Purpose

The current study assesses which are the main risk factors, clinical outcome and prognosis following the colonization of CRE in patients that underwent allo-HSCT.

Patients and Methods

A total of 343 patients subjected to allo-HSCT in the period comprised between June 2021 and June 2022 were enrolled in this retrospective study. The CRE colonization was diagnosed by clinical history and routine microbial culture of perirectal swab. In this regard, a clinical prediction model was designed based on independent risk factors underlying the pre-transplantation CRE colonization using a backward stepwise logistic regression, followed by the evaluation of its discrimination and calibration efficacies, along with clinical usefulness. Furthermore, univariate and multivariate Cox regression analyses were then conducted to assess the risk factors for post-transplantation clinical outcomes.

Results

Out of 343 patients enrolled in this study, 135 (39.3%) reported CRE colonization. The independent risk factor variables for CRE colonization were incorporated into the nomogram to build a prediction model, which showed an area under the curve of 0.767 (95% CI: 0.716–0.818), and well-fitted calibration curves (χ2 = 1.737, P = 0.9788). The patients with CRE colonization reported a significantly lower platelet engraftment rate with a higher risk of post-transplantation BSI when compared with the non-CRE colonization group (P = 0.02 and P < 0.001; respectively). The non-relapse mortality (NRM) value was higher in the CRE patients (P < 0.05), consistently with a survival probability that was thus significantly lower for the same timeframe (P < 0.05).

Conclusion

A reliable clinical prediction model for pre-transplantation CRE colonization was developed that demonstrated that the CRE colonization negatively affects platelet engraftment and survival outcomes following allo-HSCT.

Keywords:

• CRE
• Enterobacteriaceae colonization
• perirectal swab
• allo-HSCT
• risk factors
• prognosis

Data Sharing Statement

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary Materials.

Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant Nos. 81974001 and 82170222); the Jiangsu Natural Science Foundation (BK20211070); The Key Disease Program of Suzhou (LCZX202101); National Science and Technology Major Project (2017ZX09304021); National Key R&D Program of China (2019YFC0840604, 2017YFA0104502); Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD); Jiangsu Provincial Key Medical Center (YXZXA2016002); Research project of Jiangsu Provincial Health Commission (ZD2021008).

Disclosure

The authors report no conflicts of interest in this work.