Successful Cohorting Strategy in CRE-Positive Hospitalized Patients: A Single Center Experience

Introduction: Patients (pts) with Carbapenem-Resistant Enterobacteriaceae (CRE) colonization have at least a two-fold increased risk of infection than non-CRE colonized pts. Further, CRE colonization is also one of the main sources of CRE transmission in hospitals and communities and pts with hematological malignancies are particularly vulnerable to infections with CRE. In this view we started to screen for CRE colonization every pt who required hospitalization to our Hematology Section by executing a cohorting strategy.

Patients and methods: From January 2024 to July 2024 164 pts were screened at hospitalization. They were 77 males and 87 females; median age was 68.8 years. Hematological malignancies were as follow: MM 34, NHL 42, CLL 23, AML 16, ALL 9, MDS 11, CML 4, HD 5, MPN 12, ITP 5, sickle cell anemia 1, anemia from solid cancer 2.

Results: Median duration of hospitalization days for the all the 164 investigated patients was 9 days. Median white blood cell count was 7,3x10³/L, median neutrophil count was 4,0x10³/L, median lymphocyte count was 2,0x10³/L and median neutrophil to lymphocyte (N/L) ratio was 1.7. Thirty-eight out of 164 pts (23.1%) resulted positive for CRE and were all cohorted. Overall, 43/164 (26.2%) received chemotherapy (CHT) regimens while CHT was administered in 10 CRE positive pts. Fever events (FUO) were 33 out of 164 (20.1%), 25/126 (19.8%) occurred in CRE negative pts whereas 8/38 (21.0%) in CRE positive (p=1.0). No statistical differences were observed between CRE positive and negative pts as for WBC counts (p=0.4) neutrophil count (p=0.5) lymphocyte counts(p=0.07) and N/L ratio (p=0.7). Interestingly, because of the cohorting strategy, median duration of hospitalization days for CRE positive and CRE negative pts was the same (9 days).

Conclusions: Pts with hematological malignancies, because of the underlying disease, the necessary treatment and the frequent use of antibacterial drugs are at risk of CRE infections. Our internal policy of both screening and cohortization strategy allowed us to both minimize FUO events and hospitalization days in CRE positive pts. Further, screening for CRE colonization, although cost-effective, revealed to be cost saving,

No relevant conflicts of interest to declare.