title: Impact of Gut Colonization by Antibiotic-Resistant Bacteria on the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective, Single-Center Study.
abstract: Gut colonization by antibiotic-resistant bacteria may underlie hard-to-treat systemic infections. There is also accumulating evidence on the immunomodulatory function of gut microbiota after allogeneic stem cell transplantation (alloSCT) and its impact on graft-versus-host disease (GVHD). We investigated the epidemiology and clinical impact of gut colonization after alloSCT and retrospectively analyzed data on 107 alloSCTs performed at a single transplant center. Pretransplant microbiology screening identified colonization in 31% of cases. Colonization had a negative impact on overall survival after alloSCT in univariate (34% versus 74% at 24 months, P < .001) and multivariate (hazard ratio, 3.53; 95% confidence interval, 1.71 to 7.28; P < .001) analyses. Nonrelapse mortality was significantly higher in colonized than in noncolonized patients (42% versus 11% at 24 months, P = .001). Colonized patients more frequently experienced bacteremia (48% versus 24%, P = .01), and more deaths were attributable to infectious causes in the colonized group (42% versus 11% of patients and 67% versus 29% of deaths, P < .05). We observed a significantly higher incidence of grades II to IV acute GVHD in colonized than in noncolonized patients (42% versus 23%, P < .05), especially involving the gastrointestinal system (33% versus 13.5%, P = .07). In summary, we determined that gut colonization by antibiotic-resistant bacteria decreases the overall survival of patients undergoing alloSCT by increasing nonrelapse mortality and the incidences of systemic infection and acute GVHD.
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Bilinski
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Robak
authors.affiliation: Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Peric
authors.affiliation: Department of Microbiology, Central Clinical Hospital, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Halina
authors.initials: H
authors.lastname: Marchel
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Karakulska-Prystupiuk
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Halaburda
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Patrycja
authors.initials: P
authors.lastname: Rusicka
authors.affiliation: Department of Microbiology, Central Clinical Hospital, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Swoboda-Kopec
authors.affiliation: Department of Microbiology, Central Clinical Hospital, Medical University of Warsaw, Warsaw, Poland; Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Wroblewska
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wieslaw
authors.initials: W
authors.lastname: Wiktor-Jedrzejczak
authors.affiliation: Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland. Electronic address: grzegorz.basak@wum.edu.pl.
authors.forename: Grzegorz W
authors.initials: GW
authors.lastname: Basak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000502:physiology*; D006086:Graft vs Host Disease / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Antibiotic-resistant bacteria; Bacteremia; Gut colonization; Hematopoietic stem cell transplantation