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Rectal Colonization with Multidrug-Resistant Organisms and Subsequent Bloodstream Infections in Hematological
Pinelopi Kazakou1, Charalampos Charalampidis1, Ioannis Konstantellos2
14th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Chaidari, Greece.
Transplantation and Cellular Therapy
|March 30, 2026
Summary
Multidrug-resistant organism (MDRO) rectal colonization is common in patients undergoing cellular therapy. Prior colonization predicts subsequent infections, but carbapenem-resistant Gram-negative bacilli (CR-GNB) BSI rates are low, suggesting potential for de-escalation strategies.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
- Microbiology
Background:
- Bacterial bloodstream infections (BSIs) significantly impact survival in patients with hematological malignancies receiving cellular therapies.
- The relationship between rectal colonization by multidrug-resistant organisms (MDRO) and the development of subsequent BSIs requires further elucidation.
Purpose of the Study:
- To investigate the natural history and risk factors associated with MDRO colonization in patients undergoing cellular therapies.
- To evaluate the impact of MDRO colonization on the incidence of subsequent BSIs within an antimicrobial resistance setting.
Main Methods:
- Retrospective cohort study of adult hematological malignancy patients undergoing hematopoietic cell transplantation (HCT) or chimeric antigen receptor T-cell (CAR-T) therapy.
- Rectal screening for carbapenem-resistant Gram-negative bacilli (CR-GNB) and vancomycin-resistant Enterococcus faecium (VRE) was performed.
- Cox regression analysis identified predictors of colonization, and concordance between colonization and BSIs was assessed.
Main Results:
- Of 182 patients, 8.4% developed CR-GNB colonization and 23% developed VRE colonization during follow-up.
- Prior colonization with the same pathogen was a significant independent predictor for subsequent CR-GNB and VRE colonization.
- Concordant CR-GNB BSIs occurred in 18.7% of colonized patients, while VRE BSIs occurred in 4.4% of colonized patients.
Conclusions:
- Low rates of CR-GNB colonization were observed despite high MDRO prevalence, with a notable rate of concordant BSIs in colonized patients.
- VRE colonization was more frequent but rarely led to BSIs, indicating a need for tailored infection control and treatment strategies.
- Findings support the importance of infection control and may inform de-escalation of empirical antibacterial therapy for febrile neutropenia in this patient group.
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