{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:13:25Z","timestamp":1783487605991,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Multidrug-resistant (MDR) pathogens present a significant threat to hematopoietic stem cell transplant (HSCT) recipients; despite their critical implications, regional data on their infection patterns remain scarce. This study aimed to characterize the incidence, pathogen and antimicrobial resistance distribution of clinically confirmed bacterial infections among HSCT recipients. A retrospective analysis was conducted at King Hussein Cancer Center, Jordan (2018\u20132022). MDR pathogens were defined per CDC criteria. During the study period, 1157 HSCT procedures were performed. A total of 327 patients developed clinically documented bacterial infections, yielding an overall cumulative incidence of 28.3%, with a higher burden in the pediatric cohort (34.7%), including exclusive identification of Klebsiella oxytoca in pediatrics (2.3%). Gram-negative bacteria dominated, with Escherichia coli (50.5%) and Klebsiella pneumoniae (22.0%) being most common. Extended-spectrum beta-lactamase (ESBL) production was the dominant resistance mechanism (71.3%), followed by carbapenem-resistant Enterobacteriaceae (CRE; 14.1%), methicillin-resistant Staphylococcus aureus (MRSA; 8.6%), and carbapenem-resistant Pseudomonas aeruginosa (CRPA; 7.0%). The urogenital (39.1%) and bloodstream (31.2%) were the most infected sites. Significant site-specific associations were noted for ESBL production, MDR-Acinetobacter baumannii (p &lt; 0.001) and MRSA (p = 0.007). Temporal analysis revealed a convergent MDR peak in 2021. Our findings offer critical insights into MDR pathogen incidence in HSCT recipients in the Middle East, informing improved infection management and intensified antimicrobial stewardship in this high-risk population.<\/jats:p>","DOI":"10.3390\/pathogens15070684","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:58:04Z","timestamp":1782799084000},"page":"684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Epidemiology of Multidrug-Resistant Pathogens in Hematopoietic Stem Cell Transplantation (HSCT) Patients: A Five-Year Retrospective Study at a Cancer Center"],"prefix":"10.3390","volume":"15","author":[{"given":"Sawsan","family":"Mubarak","sequence":"first","affiliation":[{"name":"Infection Control Program, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joud","family":"Jarrah","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7790-4488","authenticated-orcid":false,"given":"Yara K.","family":"Edor","sequence":"additional","affiliation":[{"name":"Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Khresat","sequence":"additional","affiliation":[{"name":"Infection Control Program, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4390-4379","authenticated-orcid":false,"given":"Hadeel","family":"AlGhawrie","sequence":"additional","affiliation":[{"name":"Infection Control Program, King Hussein Cancer Center, Amman 11941, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1056\/NEJMp1215093","article-title":"The Future of Antibiotics and Resistance","volume":"368","author":"Spellberg","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5603\/AHP.a2022.0015","article-title":"Assessment of colonization and infection epidemiology in patients undergoing autologous hematopoietic stem cell transplantation: A single-center study","volume":"53","author":"Krawiec","year":"2022","journal-title":"Acta Haematol. Pol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jhin.2018.03.004","article-title":"Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: Importance of previous gut colonization","volume":"100","author":"Ferreira","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1111\/tid.12298","article-title":"Changing microbial epidemiology in hematopoietic stem cell transplant recipients: Increasing resistance over a 9-year period","volume":"16","author":"Macesic","year":"2014","journal-title":"Transpl. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.bbmt.2009.06.019","article-title":"Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: A global perspective","volume":"15","author":"Tomblyn","year":"2009","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Jia, Y., Li, Y., Liu, Y., Yang, Z., Chen, X., and Liu, Y. (2023). Epidemiology, antimicrobial resistance, and mortality risk factors of carbapenem resistant gram-negative bacteria in hematopoietic stem cell transplantation recipients. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.1098856"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1093\/cid\/cir073","article-title":"Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America","volume":"52","author":"Freifeld","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.bbmt.2016.11.005","article-title":"Risk Factors and Outcomes of Infections by Multidrug-Resistant Gram-Negative Bacteria in Patients Undergoing Hematopoietic Stem Cell Transplantation","volume":"23","author":"Patriarca","year":"2017","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_9","first-page":"603","article-title":"Changing epidemiology of bloodstream infection in a 25-years hematopoietic stem cell transplant program: Current challenges and pitfalls on empiric antibiotic treatment impacting outcomes","volume":"55","author":"Cardozo","year":"2019","journal-title":"Bone Marrow Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.2147\/IDR.S358926","article-title":"Profile and Antibiotic Pattern of Blood Stream Infections of Patients Receiving Hematopoietic Stem Cell Transplants in Southwest China","volume":"15","author":"Zeng","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.1399-3062.2010.00544.x","article-title":"Risk factors for enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients","volume":"12","author":"Mikulska","year":"2010","journal-title":"Transpl. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e2015045","DOI":"10.4084\/mjhid.2015.045","article-title":"Bacterial Infections in Hematopoietic Stem Cell Transplant Recipients","volume":"7","author":"Balletto","year":"2015","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/s00277-016-2711-1","article-title":"Infectious diseases in allogeneic haematopoietic stem cell transplantation: Prevention and prophylaxis strategy guidelines 2016","volume":"95","author":"Ullmann","year":"2016","journal-title":"Ann. Hematol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.bbmt.2012.08.012","article-title":"Timeline, Epidemiology, and Risk Factors for Bacterial, Fungal, and Viral Infections in Children and Adolescents after Allogeneic Hematopoietic Stem Cell Transplantation","volume":"19","author":"Srinivasan","year":"2013","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_15","unstructured":"Centers for Disease Control and Prevention (2024, October 23). National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS). 2024. Glossary of Terms Related to Antimicrobial Resistance, Available online: https:\/\/www.cdc.gov\/narms\/glossary\/index.html."},{"key":"ref_16","unstructured":"Leaptrot, D. (2024). Multidrug Resistant Organism and Clostridioides Difficile (MDRO\/CDI) LabID Event Reporting and Infection Surveillance, CDC."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/sj.bmt.1701520","article-title":"Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation","volume":"23","author":"Salazar","year":"1998","journal-title":"Bone Marrow Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jmii.2016.02.003","article-title":"Characteristics comparisons of bacteremia in allogeneic and autologous hematopoietic stem cell-transplant recipients with levofloxacin prophylaxis and influence on resistant bacteria emergence","volume":"51","author":"Wang","year":"2018","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_19","first-page":"12","article-title":"The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network","volume":"43","author":"Pattabiraman","year":"2021","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s15010-007-6350-2","article-title":"Infectious Complication in 314 Patients after High-Dose Therapy and Autologous Hematopoietic Stem Cell Transplantation: Risk Factors Analysis and Outcome","volume":"35","author":"Gil","year":"2007","journal-title":"Infection"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1016\/j.ijid.2012.01.015","article-title":"Healthcare-associated infection in hematopoietic stem cell transplantation patients: Risk factors and impact on outcome","volume":"16","author":"Mendes","year":"2012","journal-title":"Int. J. Infect. Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/684\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:14:14Z","timestamp":1783484054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/15\/7\/684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,28]]},"references-count":21,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["pathogens15070684"],"URL":"https:\/\/doi.org\/10.3390\/pathogens15070684","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,28]]}}}