Research Article

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

Table 1

Characteristics of patients.

Case 1Case 2Case 3Case 4

NameYeZhangChenLi

Age (year)625250

GenderMaleFemaleMaleFemale

Weight (kg)21411265.9

DiagnosisRelapsed and refractory ALL (CR)Hemophagocytic syndrome (NR)Acute monocytic leukemia (CR)Multiple myeloma

Underlying diseaseNoneNoneNoneNone

Treatment before HSCTMultiple chemotherapy; CAR-TMultiple chemotherapyMultiple chemotherapyMultiple chemotherapy

EBMT score342

Type of HSCTAllo-HSCTAllo-HSCTUCBTAuto-HSCT

Source of stem cells and donorPeripheral blood of HLA-haploidentical related donor (5/10); single cord blood of unrelated donor (7/10)Peripheral blood of HLA-haploidentical related donor (5/10); single cord blood of unrelated donor (5/10)Single cord blood of unrelated donor (7/10)Peripheral blood

Intensity of conditioningIntensified myeloablative conditioningIntensified myeloablative conditioningIntensified myeloablative conditioningMyeloablative conditioning (CBV)

Had PICC deviceYesYesYesYes

Pre-HSCT rectal swabMDRGNB repeatedly (CRE). Day –5: CRENegativeDay –11: Enterococcus faecalis (sensitive)Negative

Post-HSCT rectal swabDay +4: CRE
Day +42: CRE
Day +46: CRE
Day +10: CREDay +7: CREDay +1: CRKp
Day +9: CRKp

Duration of neutropeniaFrom day –2 to day +14 (died before engraftment)From day –4 to day +15From day –1 to day +10

Development of GVHDGrade IVNoneNoneNone

MDR bacteriaCRE (Escherichia coli)CRKP (Klebsiella pneumoniae)CRE (Escherichia coli)CRKP (Klebsiella pneumoniae)

TreatmentCombination therapy with two drugsCombination therapy with three drugsCombination therapy with four drugsCombination therapy with four drugs

OutcomeDied from acute GVHD and infectionDied from infection at day +14ImprovedImproved

Reduction in the number of transplanted T cells in haplo-HSCTYesYesYesYes

Perianal mucosal damage before BSINoneNonePerianal mucosal damagePerianal mucosal damage

ALL: acute lymphocytic leukemia; UCBT: umbilical cord blood stem cell transplantation; haplo-HSCT: haploidentical hematopoietic stem cell transplantation; allo-HSCT: allogeneic hematopoietic stem cell transplantation; auto-HSCT: autologous hematopoietic stem cell transplantation; CRE: carbapenem-resistant Enterobacteriaceae; GVHD: graft versus host disease.