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Successful Management of Unusual Multiple Gut Colonization With Extremely Drug-resistant Bacteria in an Infant Undergoing Hematopoietic Cell Transplantation

Zalas-Więcek, Patrycja PhD*; Czyżewski, Krzysztof MD, PhD; Bogiel, Tomasz PhD*; Gospodarek-Komkowska, Eugenia PhD*; Wysocki, Mariusz MD, PhD

Journal of Pediatric Hematology/Oncology: November 20, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPH.0000000000001351
Clinical and Laboratory Observations: PDF Only

Enterobacterales represent a serious threat to transplant patients due to their increase frequency of carbapenem resistance and wide spreading. We present a case of an infant with acute lymphoblastic leukemia undergoing hematopoietic stem cell transplantation. Before transplantation an unusual double colonization of the gastrointestinal tract with extremely resistant Escherichia coli and Klebsiella pneumoniae strains producing metallo-beta-lactamase was diagnosed. Respective epidemiological management was implemented, based on the strict reverse isolation in patient-protective environment, and intensified antimicrobial surveillance. After granulocyte recovery, no extremely drug-resistant strains were found, and no case of isolation and/or transmission of carbapenem-resistant bacteria has been identified in the transplant center during the following 6 months.

Departments of *Microbiology

Pediatric Hematology and Oncology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No. 1, Bydgoszcz, Poland

Supported by the Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń with funds from the maintenance of the research potential of the Department of Microbiology.

P.Z.-W.: design of the study, microbiological analysis, interpretation of the results, and writing of the manuscript. K.C.: clinical analysis and interpretation, and writing of the manuscript. T.B.: PCR analysis and interpretation, and critical revision of the manuscript. E.G.-K. and M.W.: critical revision of the manuscript.

The authors declare no conflict of interest.

Reprints: Patrycja Zalas-Więcek, PhD, Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No. 1, 9 M. Skłodowska-Curie Street, 85094 Bydgoszcz, Poland (e-mail:

Received July 1, 2018

Accepted October 18, 2018

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