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已发表论文
CRE 定植的隐匿代价：异基因造血干细胞移植后三年死亡风险增加三倍且血流感染负担升高——一项倾向评分调整研究
Authors Zhang Y, Wang R, Lyu G, Wang L, Liu X, Tian L, Huang Y, Kou J, Wu S, Cao W
Received 26 November 2025
Accepted for publication 30 January 2026
Published 10 February 2026 Volume 2026:19 579493
DOI https://doi.org/10.2147/IDR.S579493
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Hazrat Bilal
Yuan Zhang,1 Rong Wang,1 Guoqing Lyu,1– 3 Lihua Wang,1 Xiankai Liu,1 Linlin Tian,1 Yan Huang,1– 3 Jiesen Kou,1 Sun Wu,1– 3 Weijie Cao4
1Department of Hematology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People’s Republic of China; 2Key Laboratory for Leukemia Molecular Diagnosis and Treatment in Xinxiang City, Weihui, Henan Province, 453100, People’s Republic of China; 3Key Laboratory for Lymphoma Molecular Diagnosis and Treatment in Xinxiang City, Weihui, Henan Province, 453100, People’s Republic of China; 4Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
Correspondence: Sun Wu, Department of Hematology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People’s Republic of China, Email wusun@xxmu.edu.cn Weijie Cao, Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China, Email caoweijie2003@126.com
Purpose: Carbapenem-resistant Enterobacteriaceae (CRE) colonization poses a major threat to the success of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, evidence on its long-term impact and the role of decolonization strategies remains limited.
Methods: This study included 240 allo-HSCT recipients prospectively screened for pre-transplant rectal CRE colonization (colonized n=80; non-colonized n=160; 1:2 matching). Inverse probability of treatment weighting (IPTW) was applied to achieve covariate balance (standardized mean difference < 0.10). Key outcomes included CRE bloodstream infection (BSI) incidence, hematopoietic engraftment time, graft-versus-host disease (GVHD) onset, and 3-year overall survival (OS), analyzed using Kaplan-Meier curves and Cox proportional hazards models. Strain and carbapenemase enzyme concordance between colonizing and infecting isolates were evaluated in BSI cases.
Results: CRE BSI occurred almost exclusively in colonized patients (26.6%, 21/79), with 81.0% strain concordance (predominantly Escherichia coli and Klebsiella pneumoniae) and 77.8% enzyme profile concordance (mainly metallo-β-lactamase/NDM) between pre-transplant colonizing and post-transplant infecting isolates. An 81.0% concordance rate was observed between CRE strain types isolated from perianal colonization samples and those from bloodstream infections. BSI-attributable 100-day mortality was 34.8% (8/23). Colonized patients exhibited delayed engraftment (neutrophils: 14 vs 13 days, P=0.044; platelets: 15 vs 14 days, P=0.014) and earlier chronic GVHD onset (150 vs 235 days, P=0.004), with comparable GVHD incidence. Both unweighted and IPTW-adjusted 3-year OS were markedly lower in colonized patients (62.5%/58% vs 85.0%/83%; HR 3.49, 95% CI 1.91– 6.38, P< 0.001).
Conclusion: Pre-transplant CRE colonization is strongly associated with poorer allo-HSCT outcomes, including increased CRE BSI incidence and 100-day mortality, delayed engraftment, accelerated cGVHD onset, and approximately threefold higher 3-year mortality risk. These findings position CRE colonization as a potentially modifiable driver of both early and long-term morbidity, highlighting the critical need for routine screening and targeted decolonization strategies to improve survival in this high-risk population.
Keywords: carbapenem-resistant Enterobacteriaceae, allogeneic hematopoietic stem cell transplantation, graft-versus-host-disease, overall survival: non-relapse mortality
1Department of Hematology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People’s Republic of China; 2Key Laboratory for Leukemia Molecular Diagnosis and Treatment in Xinxiang City, Weihui, Henan Province, 453100, People’s Republic of China; 3Key Laboratory for Lymphoma Molecular Diagnosis and Treatment in Xinxiang City, Weihui, Henan Province, 453100, People’s Republic of China; 4Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
Correspondence: Sun Wu, Department of Hematology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People’s Republic of China, Email wusun@xxmu.edu.cn Weijie Cao, Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China, Email caoweijie2003@126.com
Purpose: Carbapenem-resistant Enterobacteriaceae (CRE) colonization poses a major threat to the success of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, evidence on its long-term impact and the role of decolonization strategies remains limited.
Methods: This study included 240 allo-HSCT recipients prospectively screened for pre-transplant rectal CRE colonization (colonized n=80; non-colonized n=160; 1:2 matching). Inverse probability of treatment weighting (IPTW) was applied to achieve covariate balance (standardized mean difference < 0.10). Key outcomes included CRE bloodstream infection (BSI) incidence, hematopoietic engraftment time, graft-versus-host disease (GVHD) onset, and 3-year overall survival (OS), analyzed using Kaplan-Meier curves and Cox proportional hazards models. Strain and carbapenemase enzyme concordance between colonizing and infecting isolates were evaluated in BSI cases.
Results: CRE BSI occurred almost exclusively in colonized patients (26.6%, 21/79), with 81.0% strain concordance (predominantly Escherichia coli and Klebsiella pneumoniae) and 77.8% enzyme profile concordance (mainly metallo-β-lactamase/NDM) between pre-transplant colonizing and post-transplant infecting isolates. An 81.0% concordance rate was observed between CRE strain types isolated from perianal colonization samples and those from bloodstream infections. BSI-attributable 100-day mortality was 34.8% (8/23). Colonized patients exhibited delayed engraftment (neutrophils: 14 vs 13 days, P=0.044; platelets: 15 vs 14 days, P=0.014) and earlier chronic GVHD onset (150 vs 235 days, P=0.004), with comparable GVHD incidence. Both unweighted and IPTW-adjusted 3-year OS were markedly lower in colonized patients (62.5%/58% vs 85.0%/83%; HR 3.49, 95% CI 1.91– 6.38, P< 0.001).
Conclusion: Pre-transplant CRE colonization is strongly associated with poorer allo-HSCT outcomes, including increased CRE BSI incidence and 100-day mortality, delayed engraftment, accelerated cGVHD onset, and approximately threefold higher 3-year mortality risk. These findings position CRE colonization as a potentially modifiable driver of both early and long-term morbidity, highlighting the critical need for routine screening and targeted decolonization strategies to improve survival in this high-risk population.
Keywords: carbapenem-resistant Enterobacteriaceae, allogeneic hematopoietic stem cell transplantation, graft-versus-host-disease, overall survival: non-relapse mortality