1 / 2019-07-19 07:57:57

Combination therapy for bloodstream infection caused by carbapenem-resistant Enterobacteriaceae in neutropenic patients after hematopoietic stem cell transplantation

bloodstream infection, carbapenem-resistant Enterobacteriaceae, multidrug‐resistance, hematopoietic stem cell transplantation, combination therapy

Combination therapy for bloodstream infection caused by carbapenem-resistant Enterobacteriaceae in neutropenic patients after hematopoietic stem cell transplantation

Xiaofan Li1,2#, Yaqun Hong1,3#, Xianling Chen1, Ping Chen1, Meiling Chen1, Yiting Wang1, Nainong Li1*
1. Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Department of Hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Street, Gulou District, Fuzhou, China;
2. INSERM U1160, Hopital Saint Louis, Université Paris Diderot, Sorbonne Paris Cité,
Paris, France;
3. The Graduate School of Fujian Medical University, No. 1 Xuefubei Street, Minhou County, Fuzhou, China.

Abstract
Bloodstream infection (BSI) caused by multidrug‐resistant bacteria (MDRB), or Extensively drug-resistant bacteria (XDRB) in immunocompromised and neutropenic patients after hematopoietic stem cell transplantation (HSCT) is a global threaten. However, effective treatment regimen is still controversial and inadequate due to the rapid deterioration, high mortality and the horrific evolution of bacteria. Here, we presented four cases that CRE was detected in neutropenic patients’ blood after HSCT. Combination therapy using polymyxin B, high-dose tigecycline, fosfomycin, and double-dose carbapenem was administrated in case 3 and case 4, and patients were survival while case 1 treating with monotherapy and case 2 that three drugs were combined died. Therefore, a strong combination therapy, as well as the emergency of new drugs might be considered in immunocompromised and neutropenic ill patients.