Outcome of Surveillance Stool Culture and Sensitivity, Followed by Needful Intervention in Patients Undergoing Hematopoietic Stem Cell Transplant at a Tertiary Care Teaching Hospital in Eastern India

Background and Aim: Patients undergoing hematopoietic stem cell transplants (HSCTs) are at high risk for acquiring healthcare-associated infections, however, invasive infection occurs initially from the gastrointestinal tract during the neutropenic phase. Materials and Methods: This was a prospective study. Stool culture and sensitivity (C/S) were sent to all patients before the conditioning regimen. Our center has a policy of performing surveillance stool cultures for all patients before transplant. These prospective analyses were aimed at studying the surveillance of stool C/S pattern on the pre-HSCT workup of patients. Results: Out of 52 HSCT patients, multiple myeloma – 24 (54%), Hodgkin lymphoma – 13 (25%), followed by mantle cell lymphoma – 5 (10%), T-cell lymphoma – 4 (8%), acute myeloid leukemia (AML) – 1 (1.5%), and severe aplastic anemia (SAA) – 1 (1.5%). Stool surveillance for C/S was sent for all 52 patients undergoing HSCT as part of pretransplant workup, which came positive in 44 patients. The most common microorganisms that came positive were Escherichia coli . The antibiotic susceptibility pattern of E. coli species from the stool surveillance for C/S showed sensitivity to aminoglycosides, piperacillin–tazobactam, meropenem, cefoperazone–sulbactam, and tigecycline. Blood for C/S was sent at times of febrile spikes in 48 (92%) of patients and it came positive in 27 (56%) of patients. The most common organism isolated was Klebsiella pneumoniae species, 10 (37%) showed sensitivity to meropenem, colistin, and tigecycline only. There was no incidence of sepsis or septic shock and also there was no death in our cohort. Conclusion: Concordance between stool C/S and subsequent blood C/S during the febrile neutropenic phase was not seen. Stool surveillance C/S also aids in guiding initial empirical antibiotic therapy during the febrile neutropenic period.