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Biol Blood Marrow Transplant. 2019 Nov;25(11):2274-2280. doi: 10.1016/j.bbmt.2019.07.019. Epub 2019 Jul 18.

Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients.

Author information

1
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina. Electronic address: matthew.kelly@duke.edu.
2
Center for Microbiome Research, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, Massachusetts.
3
Division of Pediatric Hematology and Oncology, Lucile Packard Children's Hospital, Palo Alto, California.
4
Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
5
Division of Pediatric Blood and Marrow Transplant, Duke University Medical Center, Durham, North Carolina.
6
Department of Biology, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts.
7
Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.

Abstract

The gastrointestinal tract is the predicted reservoir for most bloodstream infections (BSIs) after hematopoietic stem cell transplantation (HSCT). Whole-genome sequencing and comparative genomics have the potential to improve our understanding of the dynamics of gut colonization that precede BSI in HSCT recipients. Within a prospective cohort study of children (age <18 years) undergoing HSCT, 9 subjects met criteria for mucosal barrier injury BSI. We performed whole-genome sequencing of the blood culture isolate and weekly fecal samples preceding the BSI to compare the genetic similarity of BSI isolates to fecal strains. We evaluated temporal associations between antibiotic exposures and the abundances of BSI strains in the gut microbiota and correlated the detection of antibiotic resistance genes with the phenotypic antibiotic resistance of these strains. The median patient age was 2.6 years, and 78% were male. BSIs were caused by Escherichia coli (n = 5), Enterococcus faecium (n = 2), Enterobacter cloacae (n = 1), and Rothia mucilaginosa (n = 1). In the 6 BSI episodes with evaluable comparative genomics, the fecal strains were identical to the blood culture isolate (>99.99% genetic similarity). Gut domination by these strains preceded only 4 of 7 E. coli or E. faecium BSIs by a median of 17 days (range, 6 to 21 days). Increasing abundances of the resulting BSI strains in the gut microbiota were frequently associated with specific antibiotic exposures. E. cloacae and R. mucilaginosa were not highly abundant in fecal samples preceding BSIs caused by these species. The detection of antibiotic resistance genes for β-lactam antibiotics and vancomycin predicted phenotypic resistance in BSI strains. Bacterial strains causing mucosal barrier injury BSI in pediatric HSCT recipients were observed in the gut microbiota before BSI onset, and changes in the abundances of these strains within the gut preceded most BSI episodes. However, frequent sampling of the gut microbiota and sampling of other ecological niches is likely necessary to effectively predict BSI in HSCT recipients.

KEYWORDS:

Bloodstream infection; Hematopoietic stem cell transplantation; Microbiome

PMID:
31326608
PMCID:
PMC6861666
[Available on 2020-11-01]
DOI:
10.1016/j.bbmt.2019.07.019

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