An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality

Ali, Ritvan Kara; Sürme, Serkan; Balkan, İ̇lker İnanç; Salihoğlu, Ayşe; Özdemir, Meryem; Özdemir, Yusuf; Mete, Bilgül; Can, Günay; Ar, Muhlis Cem; Tabak, Fehmı; Saltoğlu, Neşe

doi:10.1007/s00277-020-04144-w

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…Additionally, CR is more commonly observed in non-fermenting bacteria compare to Enterobacteriaceae, especially in A. baumannii and P. aeruginosa . Most studies reported a varied detection rate of CRAB, ranging from 60% to 80%, 4 , 5 , 7 which was consistent with our data. Notably, the detection rate of CRPA displayed a worrisome trend, increasing significantly from 9.1% in 2010–2012 to 88.9% in 2019–2020, which may result from antibiotic exposure and regional differences.…”

Section: Discussionsupporting

confidence: 92%

“…Recently, several studies have consistently proved an increasing trend of CR rates among these two major groups of bacteria in HMs patients with BSI. 4 , 6 , 11 Similarly, in line with the results of a European study, 4 our findings revealed that CR was undetectable among Enterobacteriaceae in 2010–2012, but upgraded to 14.8% in E. coli and 32% in K. pneumoniae during 2019–2020. Additionally, CR is more commonly observed in non-fermenting bacteria compare to Enterobacteriaceae, especially in A. baumannii and P. aeruginosa .…”

Section: Discussionsupporting

confidence: 90%

“… 1–3 With an elevated prevalence reported, CRGNB BSI is a serious threat to patients, and particularly in developing countries. 4–6 For example, the prevalence of CRE BSI in China increased from 12.5% 5 in 2014 to 26.8% in 2019 (According to the China Antimicrobial Surveillance Network). Meanwhile, a previous study had reported the rate of carbapenem resistance in Acinetobacter baumannii was 18% in 2012, but sharply raised to 60% in 2019.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there are a series of studies focusing on the clinical characteristics and prognosis of CRE BSI in HM patients, and most results show that the incidence of CRE BSI exhibits an increased tendency. 4 , 6 , 11 Actively surveillance and infection control measures dramatically decreased CRE colonization thereby reducing mortality. 13–15 Importantly, BSI caused by CRNFB should be a matter of great concern, since limited data suggested that NFB displayed a greater carbapenem resistance rate as well as a higher mortality rate than CRE, 16 , 17 30-day mortality rate up to 45%–100%.…”

Section: Introductionmentioning

confidence: 99%

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The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections

Lu¹,

Xu²,

Tang³

et al. 2022

IDR

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Background Carbapenem-resistant Gram-negative bacteria (CRGNB) bloodstream infection (BSI) pose a significant threat to the prognosis of hematologic malignancies (HM) patients. Understanding the distribution of pathogenic bacteria, changes in carbapenem-resistant trends, risk factors for CRGNB infections, and exploring the early detection measures can help reduce mortality. Methods We conducted a multicenter retrospective study of Gram-negative bacteria (GNB) BSI in patients with HM in three university-affiliated hospitals in Hunan Province, China, from January 2010 to December 2020. Demographic and clinical data were collected from the hospital electronic medical records system. Results CRGNB caused 138 (15.3%) of 902 GNB BSI. The detection rate of CRGNB increased from 6.4% in 2010–2012 to 35.4% in 2019–2020. The 7-day mortality rate was significantly higher in patients with CRGNB BSI than in patients with carbapenem-susceptible Gram-negative bacteria (CSGNB) BSI [31.9% (44/138) vs 9.7% (74/764), P < 0.001], and the mortality rate in patients with carbapenem-resistant non-fermenting bacteria (CRNFB) bloodstream infections was generally higher than that of carbapenem-resistant Enterobacteriaceae (CRE). Urinary catheter (OR, 2.814; CI=1.395–5.680; P=0.004) and prior exposure to carbapenem (OR, 4.372; CI=2.881–6.635; P<0.001) were independent risk factors for CRGNB BSI. Analysis of co-infections showed that 50%–85% of patients with CRGNB BSI had pulmonary infections, sputum culture results suggested that sputum culture positivity rate was as high as 57.1%–66.7% in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) and Stenotrophomonas maltophilia BSI, and the results of antimicrobial susceptibility testing of sputum cultures were consistent with the blood cultures. Conclusion Carbapenem resistance has dramatically increased in HM patients with GNB BSI in recent years and is associated with a worse outcome, especially for non-fermenting bacteria. In high-risk patients, early screening of the respiratory tract specimens may help to detect CRNFB colonization and protect patients from breakthrough BSI.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections

Lu¹,

Xu²,

Tang³

et al. 2022

IDR

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“…In Turkey, Kara Ali et al [67] studied a cohort of hospitalized patients with HM and BSIs in the period between 2006 and 2016, of which Enterobacteriaceae accounted for 86% of the GNBs. From the first reported case in 2010, there was an increasing trend in carbapenem resistance among Enterobacteriaceae, which was 6.5% in E. coli and 32.8% in Klebsiella spp.…”

Section: The Epidemiology Of Cre In Hm Patientsmentioning

confidence: 99%

Carbapenem-Resistant Enterobacteriaceae—Implications for Treating Acute Leukemias, a Subgroup of Hematological Malignancies

et al. 2021

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Acute leukemias (AL) are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. Patients with AL are highly susceptible to infectious diseases due to the disease itself, factors attributed to treatment, and specific individual risk factors. Enterobacteriaceae presence (e.g., Klebsiella pneumonia and Escherichia coli) is a frequent cause of bloodstream infections in AL patients. Carbapenem-resistant Enterobacteriaceae (CRE) is an emerging health problem worldwide; however, the incidence of CRE varies greatly between different regions. Carbapenem resistance in Enterobacteriaceae is caused by different mechanisms, and CRE may display various resistance profiles. Bacterial co-expression of genes conferring resistance to both broad-spectrum β-lactam antibiotics (including carbapenems) and other classes of antibiotics may give rise to multidrug-resistant organisms (MDROs). The spread of CRE represents a major treatment challenge for clinicians due to lack of randomized clinical trials (RCTs), a limited number of antibiotics available, and the side-effects associated with them. Most research concerning CRE infections in AL patients are limited to case reports and retrospective reviews. Current research recommends treatment with older antibiotics, such as polymyxins, fosfomycin, older aminoglycosides, and in some cases carbapenems. To prevent the spread of resistant microbes, it is of pivotal interest to implement antibiotic stewardship to reduce broad-spectrum antibiotic treatment, but without giving too narrow a treatment to neutropenic infected patients.

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Quinoline-2-one derivatives as promising antibacterial agents against multidrug-resistant Gram-positive bacterial strains

Alzahrani

2023

Braz J Microbiol

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An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality

Cited by 19 publications

References 29 publications

The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections

The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections

Carbapenem-Resistant Enterobacteriaceae—Implications for Treating Acute Leukemias, a Subgroup of Hematological Malignancies

Quinoline-2-one derivatives as promising antibacterial agents against multidrug-resistant Gram-positive bacterial strains

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