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- Title
Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study.
- Authors
de la Court, Jara R.; Woudt, Sjoukje H. S.; Schoffelen, Annelot F.; Heijmans, Jarom; de Jonge, Nick A.; van der Bruggen, Tjomme; Bomers, Marije K.; Lambregts, Merel M. C.; Schade, Rogier P.; Sigaloff, Kim C. E.; ISIS-AR study group; Stuart, J. W. T. Cohen; Melles, D. C.; van Dijk, K.; Alzubaidy, A.; Werdmuller, B. F. M.; Blaauw, G. J.; Diederen, B. M. W.; Alblas, H. J.; der Kuil, W. Altorf-van
- Abstract
Objectives: Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization. Methods: Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates). Results: We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate. Conclusions: This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.
- Subjects
GRAM-negative bacteria; BACTEREMIA; THIRD generation cephalosporins; COLONIZATION; CHEMOTHERAPY complications; DRUG resistance in microorganisms
- Publication
Annals of Clinical Microbiology & Antimicrobials, 2022, Vol 21, Issue 1, p1
- ISSN
1476-0711
- Publication type
Article
- DOI
10.1186/s12941-022-00544-0