Clinical outcome from hematopoietic cell transplant patients with bloodstream infection caused by carbapenem-resistant P. aeruginosa and the impact of antimicrobial combination in vitro

Jessica Fernandes Ramos; Gleice Leite; Roberta Cristina Ruedas Martins; Camila Rizek; Sabri Saeed Al Sanabani; Flavia Rossi; Thais Guimarães; Anna Sara Levin; Vanderson Rocha; Silvia Figueiredo Costa

doi:10.1007/s10096-021-04361-9

Clinical outcome from hematopoietic cell transplant patients with bloodstream infection caused by carbapenem-resistant P. aeruginosa and the impact of antimicrobial combination in vitro

Eur J Clin Microbiol Infect Dis. 2022 Feb;41(2):313-317. doi: 10.1007/s10096-021-04361-9. Epub 2021 Oct 15.

Authors

Jessica Fernandes Ramos^{1

2}, Gleice Leite³, Roberta Cristina Ruedas Martins⁴, Camila Rizek⁴, Sabri Saeed Al Sanabani⁵, Flavia Rossi⁶, Thais Guimarães^{1

4}, Anna Sara Levin^{1

4}, Vanderson Rocha^{2

7}, Silvia Figueiredo Costa^{1

4}

Affiliations

¹ Department of Infectious Diseases of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil.
² Department of Haematology, Hemotherapy and Cellular Therapy of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil.
³ Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil. gleice.c.leite@gmail.com.
⁴ Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil.
⁵ Laboratory of Medical Investigation - LIM 52 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil.
⁶ Laboratory of Clinical Microbiology of Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil.
⁷ Haematology Department, NHS BT, Oxford University, Oxford, UK.

PMID: 34651217
DOI: 10.1007/s10096-021-04361-9

Abstract

Bloodstream infection (BSI) caused by carbapenem-resistant P. aeruginosa (CRPA) has high mortality in hematopoietic stem cell transplant (HSCT) recipients. We performed MIC, checkerboard, time-kill assay, PFGE, PCR, and whole genome sequence and described the clinical outcome through Epi Info comparing the antimicrobial combination in vitro. Mortality was higher in BSI caused by CRPA carrying the lasB virulence gene. The isolates were 97% resistant to meropenem displaying synergistic effect to 57% in combination with colistin. Seventy-three percent of the isolates harbored bla_SPM-1 and Tn4371 and belonged to ST277. The synergistic effect in vitro with meropenem with colistin appeared to be a better therapeutic option.

Keywords: Bloodstream infection; Carbapenem-resistant Pseudomonas aeruginosa; Multidrug resistance; Stem cell transplant; Synergism; Virulence.

MeSH terms

Adolescent
Adult
Anti-Bacterial Agents / therapeutic use*
Brazil
Carbapenem-Resistant Enterobacteriaceae
Carbapenems
Colistin / therapeutic use
Female
Hematopoietic Stem Cell Transplantation*
Humans
Male
Meropenem / therapeutic use
Microbial Sensitivity Tests
Middle Aged
Pseudomonas Infections / drug therapy*
Pseudomonas Infections / microbiology
Pseudomonas aeruginosa / genetics
Pseudomonas aeruginosa / isolation & purification
Sepsis / drug therapy*
Sepsis / mortality
Young Adult

Substances

Anti-Bacterial Agents
Carbapenems
Meropenem
Colistin