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Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients.

Publication ,  Journal Article
Kelly, MS; Ward, DV; Severyn, CJ; Arshad, M; Heston, SM; Jenkins, K; Martin, PL; McGill, L; Stokhuyzen, A; Bhattarai, SK; Bucci, V; Seed, PC
Published in: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
November 2019

The gastrointestinal tract is the predicted reservoir for most bloodstream infections (BSIs) after hematopoietic stem cell transplantation (HSCT). Whole-genome sequencing and comparative genomics have the potential to improve our understanding of the dynamics of gut colonization that precede BSI in HSCT recipients. Within a prospective cohort study of children (age <18 years) undergoing HSCT, 9 subjects met criteria for mucosal barrier injury BSI. We performed whole-genome sequencing of the blood culture isolate and weekly fecal samples preceding the BSI to compare the genetic similarity of BSI isolates to fecal strains. We evaluated temporal associations between antibiotic exposures and the abundances of BSI strains in the gut microbiota and correlated the detection of antibiotic resistance genes with the phenotypic antibiotic resistance of these strains. The median patient age was 2.6 years, and 78% were male. BSIs were caused by Escherichia coli (n = 5), Enterococcus faecium (n = 2), Enterobacter cloacae (n = 1), and Rothia mucilaginosa (n = 1). In the 6 BSI episodes with evaluable comparative genomics, the fecal strains were identical to the blood culture isolate (>99.99% genetic similarity). Gut domination by these strains preceded only 4 of 7 E. coli or E. faecium BSIs by a median of 17 days (range, 6 to 21 days). Increasing abundances of the resulting BSI strains in the gut microbiota were frequently associated with specific antibiotic exposures. E. cloacae and R. mucilaginosa were not highly abundant in fecal samples preceding BSIs caused by these species. The detection of antibiotic resistance genes for β-lactam antibiotics and vancomycin predicted phenotypic resistance in BSI strains. Bacterial strains causing mucosal barrier injury BSI in pediatric HSCT recipients were observed in the gut microbiota before BSI onset, and changes in the abundances of these strains within the gut preceded most BSI episodes. However, frequent sampling of the gut microbiota and sampling of other ecological niches is likely necessary to effectively predict BSI in HSCT recipients.

Duke Scholars

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Published In

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

DOI

EISSN

1523-6536

ISSN

1083-8791

Publication Date

November 2019

Volume

25

Issue

11

Start / End Page

2274 / 2280

Related Subject Headings

  • Prospective Studies
  • Male
  • Intestinal Mucosa
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Gastrointestinal Microbiome
  • Female
  • Drug Resistance, Bacterial
  • Child, Preschool
 

Citation

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MLA
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Kelly, M. S., Ward, D. V., Severyn, C. J., Arshad, M., Heston, S. M., Jenkins, K., … Seed, P. C. (2019). Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 25(11), 2274–2280. https://doi.org/10.1016/j.bbmt.2019.07.019
Kelly, Matthew S., Doyle V. Ward, Christopher J. Severyn, Mehreen Arshad, Sarah M. Heston, Kirsten Jenkins, Paul L. Martin, et al. “Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients.Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation 25, no. 11 (November 2019): 2274–80. https://doi.org/10.1016/j.bbmt.2019.07.019.
Kelly MS, Ward DV, Severyn CJ, Arshad M, Heston SM, Jenkins K, et al. Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019 Nov;25(11):2274–80.
Kelly, Matthew S., et al. “Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients.Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 25, no. 11, Nov. 2019, pp. 2274–80. Epmc, doi:10.1016/j.bbmt.2019.07.019.
Kelly MS, Ward DV, Severyn CJ, Arshad M, Heston SM, Jenkins K, Martin PL, McGill L, Stokhuyzen A, Bhattarai SK, Bucci V, Seed PC. Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019 Nov;25(11):2274–2280.
Journal cover image

Published In

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

DOI

EISSN

1523-6536

ISSN

1083-8791

Publication Date

November 2019

Volume

25

Issue

11

Start / End Page

2274 / 2280

Related Subject Headings

  • Prospective Studies
  • Male
  • Intestinal Mucosa
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Gastrointestinal Microbiome
  • Female
  • Drug Resistance, Bacterial
  • Child, Preschool