To evaluate the clinical, microbiological and antibiotic resistance profile of strains isolated from bacteremia samples, in Bone Marrow Transplant (BMT) recipients in a specialized tertiary unit, in Fortaleza, Ceará (Brazil). Furthermore, evaluate possible measures to prevent these diseases in Hematology services.

A Microsoft Excel® spreadsheet with clinical and laboratory data from BMT recipients with bacteremia was created and completed over the years 2020‒2023. The data was analyzed by the group of authors. The study was approved by the Research Ethics Committee, opinion number 3.697.674. The bacterial group was considered resistant when more than 30% of its strains, isolated from bacteremia in BMT recipients, did not show inhibition by the antibiotic tested.

34 patients were included in the study, 32.3% of whom were women. 61.6% of patients had bacteremia due to Pseudomonas spp. (20.6%), Staphylococcus spp. (20.6%) and Klebsiella spp. (20.6%), followed by Sphingomonas Paucimobilis (14.7%), E. Coli (11.8%) and others (11.8%). Pseudomonas spp. showed resistance to: amikacin (57.1%), cefepime (85.7%), ceftazidime (85.7%), ceftriaxone (42.9%), cefuroxime (51.1%), colistin (42.9%) and nitrofurantoin (42.9%). Staphylococcus spp. showed resistance to: benzylpenicillin (42.9%), erythromycin (71.4%) and clindamycin (42.9%). Klebsiella spp. showed resistance to: ampicillin (71.4%), ampicillin with sulbactam (57.1%), cefepime (85.7%), ceftazidime (85.7%), cefuroxime (85.7%), ciprofloxacin (85. 7%), colistin (85.7%), linezolid (57.1%), nitrofurantoin (85.7%) and rifampin (85.7%). E. coli showed resistance to: ampicillin (75.0%), ampicillin with sulbactam (75.0%), cefuroxine (50.0%), ciprofloxacin (50.0%), colistin (50.0%), streptomycin (50.0%) and rifampicin (50.0%). Sphingomonas paucimobilis did not show significant antimicrobial resistance.

Many factors are associated with bacteremia in BMT recipients, such as cytomegalovirus, neutropenia, mucositis, use of antimicrobials, among others (Garnica et al, 2022). In this study, Gram-Negative (GN) bacteremia predominated, a finding consistent with the literature, despite the increased prevalence of Staphylococcus spp., which is mainly associated with catheter infections. Early identification of these pathogens, with appropriate treatment, is capable of containing the hospital spread of multiresistant organisms. The Hematology, BMT and Hospital Infection Control services must work together to identify these cases, look for causal situations and develop a multidisciplinary strategy to prevent infections associated with hospital care, especially in immunosuppressed patients, such as those in this study.

GN bacteria were the main sources of infection and multidrug resistance in the present study. Multidisciplinary coordination between the Hematology and Hospital Infection Control Committees is adequate for the prevention and treatment of these conditions. Contrary to the literature, there were a large number of infections caused by Staphylococcus spp., reinforcing the need for surveillance in patients using long-term catheters, in addition to the correct indication of this procedure in BMT recipients.