Central line-associated bloodstream infection in two allogeneic hematopoietic cell transplant recipients.

INTRODUCTION

is a gram-negative, opportunistic phytopathogen that rarely causes human infections. We report two cases of central line-associated bloodstream infection (CLABSI) in allogeneic hematopoietic cell transplantation (alloHCT) recipients. We review previous reports and common microbiological characteristics associated with this organism.

CASE REPORTS

Two adult males developed CLABSIs at day +81 and day +77 post-alloHCT. Patient one was asymptomatic on presentation while patient two was febrile. One patient had a polymicrobial infection, which has not been previously described. The presence of high-level ceftazidime resistance in both patients suggests third-generation cephalosporin resistance may be more common than previously recognized.

MANAGEMENT AND OUTCOME

For both patients, microbiologic clearance was achieved through peripherally inserted central catheter removal and initiation of intravenous cefepime. Antibiotic therapy was narrowed to oral levofloxacin for a total 14-day course from the time of first negative blood culture. There has been no subsequent recurrence of infection at 12 and 5 months of follow-up for patients one and two, respectively.

DISCUSSION

These two cases add to the scant literature characterizing infection following alloHCT. Immunosuppressive agents for graft-versus-host disease prophylaxis may have predisposed these patients to infection. Our reports, and previously reported cases, suggest exhibits low virulence, mild symptom burden, and does not confer a high mortality risk. In the alloHCT setting, further accumulation of cases is needed to aid in understanding clinical features and characteristics of infection.