Emergency Combination of Four Drugs for Bloodstream Infection Caused by Carbapenem-Resistant Enterobacteriaceae in Severe Agranulocytosis Patients with Hematologic Malignancies after Hematopoietic Stem Cell Transplantation

Abstract EN

Bloodstream infection (BSI) caused by multidrug-resistant (MDR) bacteria or extensively drug-resistant (XDR) bacteria is a global threat.

However, an effective treatment regimen is still controversial and inadequate due to the rapid deterioration caused by the bacteria.

In immunocompromised and neutropenic patients, MDR-BSI is an emergency, which causes treatment-related mortality.

In this study, four agranulocytosis patients with hematologic malignancies after HSCT receiving treatment for carbapenem-resistant Enterobacteriaceae- (CRE-) BSI were included.

Conventional treatment using two to three combined antibiotics was administered in the first and second patients.

Combination treatment using four drugs, polymyxin B, high-dose tigecycline, fosfomycin, and double-dose carbapenem, was administered in the third and fourth patients.

None of the patients receiving conventional treatment survived.

Both patients receiving combination treatment using four drugs survived.

Therefore, four-drug combination therapy may be needed in CRE-BSI patients who experienced severe agranulocytosis after HSCT.

The efficacy of the four-drug combination treatment for CRE-BSI patients as well as the adverse effects need to be further studied.