Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Dec;19(6):10.1111/tid.12762.
doi: 10.1111/tid.12762. Epub 2017 Oct 25.

Multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus: Three major threats to hematopoietic stem cell transplant recipients

Michael J Satlin  1   2 , Thomas J Walsh  1   2   3
Affiliations
Review

Multidrug-resistant Enterobacteriaceae, Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus: Three major threats to hematopoietic stem cell transplant recipients

Michael J Satlin et al. Transpl Infect Dis. 2017 Dec.

Abstract

Hematopoietic stem cell transplant (HSCT) recipients are uniquely threatened by the emergence of multidrug-resistant (MDR) bacteria because these patients rely on immediate active antimicrobial therapy to combat bacterial infections. This review describes the epidemiology and treatment considerations for three challenging MDR bacterial pathogens in HSCT recipients: MDR Enterobacteriaceae, including extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus (VRE). These bacteria are common causes of infection in this population and bacteremias caused by these organisms are associated with high mortality rates. Carbapenems remain the treatments of choice for serious infections due to ESBL-producing Enterobacteriaceae in HSCT recipients. Administration of β-lactam agents as an extended infusion is associated with improved outcomes in patients with severe infections caused by P. aeruginosa. Older agents used for the treatment of CRE and MDR P. aeruginosa infections, such as polymyxins and aminoglycosides, have major limitations. Newer agents, such as ceftazidime-avibactam and ceftolozane-tazobactam have great potential for the treatment of Klebsiella pneumoniae carbapemenase-producing CRE and MDR P. aeruginosa, respectively, but more pre-clinical and clinical data are needed to better evaluate their efficacy. Daptomycin dosages ≥8 mg/kg/day are recommended to treat VRE infections in this population, particularly in the setting of increasing daptomycin resistance. Strategies to prevent these infections include strict adherence to recommended infection control practices and multidisciplinary antimicrobial stewardship. Last, gastrointestinal screening to guide empirical therapy and the use of polymerase chain reaction-based rapid diagnostics may decrease the time to administration of appropriate therapy for these infections, thereby leading to improved outcomes.

Keywords: Enterobacteriaceae; carbapenemases; extended-spectrum β-lactamases; hematopoietic stem cell transplantation, Pseudomonas aeruginosa; vancomycin-resistant enterococci.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of Interest

Dr. Satlin has received research grants from Allergan and Merck. Dr. Walsh has received research grants from Allergan, Medicines Company, and Merck and serves as an advisor to Allergan and Pfizer.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: An overview of infection risks and epidemiology. Infect Dis Clin North Am. 2010;24:257–272. - PubMed
    1. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64:328–340. - PubMed
    1. Forkner CE, Jr, Frei E, 3rd, Edgcomb JH, Utz JP. Pseudomonas septicemia; observations on twenty-three cases. Am J Med. 1958;25:877–889. - PubMed
    1. Schimpff SC, Greene WH, Young VM, Wiernik PH. Pseudomonas septicemia: Incidence, epidemiology, prevention and therapy in patients with advanced cancer. Eur J Cancer. 1973;9:449–455. - PubMed
    1. Bodey GP, Rodriguez V, Luce JK. Carbenicillin therapy of gram-negative bacilli infections. Am J Med Sci. 1969;257:408–414. - PubMed

MeSH terms

Substances