Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation

Figures & data

Table 1 Data on MDRO Recovered from Surveillance Cultures and Viral/Parasitic Serostatus of Patients Admitted to the HSCT Unit

	Surveillance MDRO culture- samples Recovered from Multi-body sites^A								Viral/parasite serological assessment^B positive samples
	rectum	nasal	axilla	groin	eye	sputum	urine	vagina
CRE	4	Not Tested			0	1	2	0	Cytomegalovirus (IgM)	3
ESBLs	17	Not Tested			0	0	4	2	Epstein Barr virus (IgM)	2
MRSA	Not Tested	8	16	19	2	0	0	1	Toxoplasma gondii (IgM)	1

Notes: ^AMulti-body sites tested included the eye, ear, sputum, urine, blood, anus, and vagina. ^BVirology screening included HSV-1, HSV-II, CMV, EBV, HBsAg, HBcAb, HCV, HIV, Toxoplasma, and rapid testing for COVID-19.

Figure 1 Distribution of Multidrug-resistance organisms (MDRO) pre- and post-HSCT.

Figure 2 Antimicrobial resistance profile of CRE and ESBLs post-HSCT.

Table 2 Demographic Data of Enrolled Patients Pre- and Post-HSCT

Patient demographics/clinical characteristics	Pre-transplant colonization			Post-transplant (pre-engraftment period)
	Group 1: Colonized by MDRO (N=32)	Group 2: Not colonized by MDRO (N= 8)	p-value	Group 1: Infected by MDRO (N= 9)	Group 2: Not infected by MDRO (N=31)	p-value
Gender
Male	18	7	0.10	6	19	0.76
Female	14	1		3	12
Age
>30 years	6	0	0.18	2	6	0.84
<31 years	26	8		7	25
Underlying disease
Multiple myeloma	8	3	0.77	1	10	0.36
R-Hodgkin lymphoma	9	1		2	8
Acute myeloid leukemia	5	1		1	5
Others^A	10	3		5	8
Type of transplant
Autologous	19	6	0.41	3	22	0.04*
Allogeneic	13	2		6	9

Notes: Others ^Achronic myeloid leukemia, acute myeloid leukemia, and relapsed/refractory diffuse large B-cell lymphoma. *means significant (p value˂ 0.05).

Table 3 Relationship Between Pre-Transplant Screening and Post-Transplant Infections Among HSCT Recipients

Microbiological profile	N (%) of patients colonized by surveillance culture/other body sites	N (%) of patients colonized and subsequent infection with the same isolate type post-HSCT	Type of hospital-acquired infection	N (%) patients colonized and after applying infection control interventions they did not develop subsequent infections post-HSCT
Gram-negative bacilli
ESBLs: E. coli and K. pneumoniae.	18 (45%)	1 (5.5%)	BSI caused by E. coli	17 (94.5%)
CRE: E. coli and K. pneumoniae	6 (15%)	0	0	6 (100%)
A. baumannii	3(7.5%)	1(33.3%)	BSI	2(66.7%)
Pseudomonas spp.	3(7.5%)	0	0	3(100%)
Gram-positive cocci
MRSA	26 (65%)	0	0	26 (100%)
Staphylococcus aureus	1(2.5%)	0	0	1(100%)
Coagulase-negative staphylococci	11(27.5%)	0	0	11(100%)

Notes: Staphylococcus aureus and methicillin resistant Staphylococcus aureus by oxacillin-resistant screening agar base medium (Oxoid, UK) and a cefoxitin disk (30 μg) as recommended by clinical laboratory standard institute.

Table 4 Association Between Colonization State by MDRO Prior to Transplant and Infection by Same MDRO Post-Transplant

Groups	Number of patients colonized prior to transplant by causative microorganism(s)			P value
Number of patients infected post-transplant by MDRO as ESBLs, CRE, and MRSA		Yes	No	0.037*
	Yes	5	4
	No	27	4
Number of patients infected post-transplant by CRE		Yes	No	0.000*
	Yes	3	1
	No	3	33
Number of patients infected post-transplant by ESBLs		Yes	No	0.810
	Yes	2	3
	No	16	19
Number of patients infected post–transplant by MRSA		Yes	No	1.00
	Yes	0	0
	No	26	14

Note: *means significant (p value˂ 0.05).

Data Sharing Statement

All data generated or analyzed during this study are included in this published article in the main manuscript.