Emergence of non-susceptibility during persistent bacteraemia in haematopoietic cell transplant recipients and haematological malignancy patients.

Background: Systematic studies pertaining to the emergence of resistance during therapy of bloodstream infections (BSIs) in haematopoietic cell transplant (HCT) recipients and haematological malignancy (HM) patients are lacking.

Objectives: To determine how frequently non-susceptibility emerges during therapy of BSIs and to compare these findings with non-HCT/HM patients.

Patients And Methods: BSIs that occurred at our institution between 1 July 2012 and 31 October 2019 in HCT/HM patients and non-HCT/HM patients were identified. Episodes in which bacteraemia persisted while on appropriate therapy ('persistent BSI') were evaluated for emergence of non-susceptibility during therapy.

Results: In total, 96 BSI episodes among 86 HCT/HM patients were analysed. Eight persistent BSI episodes (8.3%) occurred in eight patients (9.3%). Repeat susceptibility testing was performed in seven (87.5%) of these episodes. Non-susceptibility to the treatment agent emerged in five (71.4%) episodes and to any antipseudomonal agent in seven (100%) episodes. The 21 day mortality rate associated with persistent BSI was 87.5% (seven of eight), and it was 80% (four of five) among persistent BSI episodes in which non-susceptibility to the treatment agent emerged on therapy. Non-susceptibility to any antipseudomonal agent during persistent BSI emerged significantly more frequently in HCT/HM patients compared with non-HCT/HM patients.

Conclusions: Non-susceptibility emerges frequently during persistent BSIs in HCT/HM patients, and this is associated with a high mortality rate. Our findings have implications for the management of persistent BSIs in these patients. Larger studies are needed to confirm and expand on our findings.