A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). We retrospectively studied the clinical data of 395 consecutive HSCT patients from September 2017 to April 2019. From September 2017 to June 2018 (period 1), 200 patients received single CRE screening before transplantation. From July 2018 to April 2019 (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P < 0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 h of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 h after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 h after fever onset and died of septic shock. The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.

中文翻译：

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造血干细胞移植患者对碳青霉烯类耐药肠杆菌的筛查频率不同：哪个更好？

已经达成共识，在免疫抑制的个体中对碳青霉烯类耐药的肠杆菌科（CRE）进行筛查可以降低CRE血流感染（BSI）的发生率。我们回顾性研究了2017年9月至2019年4月连续395例HSCT患者的临床数据。从2017年9月至2018年6月（第1期），有200例患者在移植前接受了一次CRE筛查。从2018年7月到2019年4月（期间2），入院后对195名患者进行了连续的每周CRE筛查。对于定植于CRE的患者，接受了针对性的管理：（1）接触预防措施，以及（2）必要时进行以CRE为目标的抢先治疗。在第1阶段中，检测到3例CRE定植的患者（1.5％）。CRE BSI率为2.0％（4例患者），相关的30天死亡率为50.0％（4例患者中有2例）。在第2阶段中，共检出21例CRE菌落患者，检出率显着高于第1阶段（P <0.001）。在这21例定植的患者中，第一次筛查发现4例（19.0％）CRE阳性，第二次筛查发现5例（23.8％），第三次或更晚发现其余12例（57.1％）筛选。CRE BSI率降至0.5％（1/195），并且没有CRE相关的死亡。15名定植的患者发生了中性粒细胞减少症。在发烧的24小时内，先后用替加环素处理了13个定植者，并实现了快速的温度控制。一名定植者在发烧后48小时后接受了替加环素，由于多粘菌素的添加最终得以存活。另一例在发烧后72小时后接受替加环素治疗，死于败血性休克。筛查频率的增加有助于发现CRE定植的患者。这些定植患者的靶向治疗可能有助于降低CRE BSI的发生率和死亡率，从而改善患者的预后。