Prevalence of CRE Colonization in Hematopoietic Stem Cell Transplant Recipients and Its Impact on Clinical Outcomes: Experience from a Developing Country

Abstract

Objectives: To assess impact of CRE colonization on infectious complications and transplant-related outcomes.

Methodology: This single-center prospective study, conducted at the Clinical Hematology and Bone Marrow Transplant Department, National University of Medical Sciences, Rawalpindi, Pakistan, included 173 patients who received HSCT between January 2023 and May 2025. Stool samples were analyzed for CRE colonization before start of conditioning protocol. Statistical analysis was done using SPSS version 27.

Results: Median age at time of transplant was 30 (range: 1-69) years. Of 173 patients included in the study, 114 (65.9%) were CRE-positive, while 59 (34.1%) were negative. CRE-positive patients had higher incidence of febrile neutropenia (93% vs. 84.7%, p=0.08). CRE-targeted antibiotics were required in 38.6% CRE-positive patients compared to 25.4% CRE-negative patients (p=0.08). After starting CRE-targeted antibiotics, fever resolved in median 2 days in CRE-positive group compared to median 3 days in CRE-negative group (p=0.59). CRE non-colonized patients had better OS of 91.5% with mean survival 728 days (95% CI: 668-718 days) compared to CRE colonized patients who had OS of 81.4% with mean survival of 642 days (95% CI: 580-704 days, p=0.12).

Conclusion: Our single-center study demonstrates that patients with CRE-colonization before hematopoietic stem cell transplant have a trend towards inferior transplant outcomes and increased complications compared to CRE non-colonized patients.