Rectal Swab Screening as a Predictor of Bacteremia by Multidrug-resistant Microorganisms in Children With...

Hematopoietic stem cell transplantation (HSCT) is a curative treatment but carries a high mortality risk due to infections from immunosuppression. Infections by multidrug-resistant (MDR) pathogens are rising, and rectal screening may predict bacteremia and reduce mortality. This study aims to evaluate the utility of periodic rectal screening in predicting MDR-induced bacteremia by day 100 in pediatric HSCT patients.

A retrospective cohort study was conducted in patients under 18 who underwent rectal screening before HSCT at a high-complexity center between 2018 and 2022. Descriptive analysis and regression models identified risk factors for bacteremia and mortality.

Two hundred ten HSCT procedures were analyzed. MDR colonization was found in 51.9% of patients, with 18.1% of colonized individuals developing bacteremia. Colonization was a significant risk factor for MDR Gram-negative bacteremia (relative risk ratio 7.25, 95% CI: 1.97-26, P = 0.003), and was associated with higher mortality ( P = 0.034).

Rectal screening effectively identifies MDR bacterial colonization in pediatric HSCT patients and facilitates targeted empirical antibiotic therapy adjustments, representing a valuable tool for clinical management in this population.