Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study

Abstract

Background: Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. Methods:We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. Results:In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. Conclusions:Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases. Chemotherapy, n (%) 6542 (81.1) Febrile neutropenia, n (%) 1100 (13.6) G-CSF, n (%) 4039 (50.1) Central venous catheter, n (%) 3072 (38.1) Urinary catheter, n (%) 2109 (26.2) HSCT, n (%) Allogeneic 407 (5.0) Autologous 301 (3.7) Isolation room, n (%) 2352 (29.2)In-hospital mortality, n (%)

Frequency of microbial isolates and pattern of antimicrobial resistance in patients with hematological malignancies: a cross-sectional study from Palestine

“…The mean age ± SD of the study participants was 40.8 ± 16.6 years, ranging from 17 to 84 years old. The most common hematologic malignancy was acute lymphoid leukemia (ALL) (36, 25%), followed by Hodgkin's lymphoma (33,22.9%), acute myeloid leukemia (30, 20.8%), multiple myeloma (22, 15.3), non-Hodgkin lymphoma (16,11.1%), chronic lymphoid leukemia (4, 2.8%), Waldenstrom macroglobulinemia (2, 1.4%) and Langerhans cell histiocytosis (1, 0.7%). Most of these patients were actively on the chemotherapy protocol (83, 57.6%) or had had bone marrow transplantation (35, 24.3%), while others had finished their treatment (17, 11.8%) or had not received any cancer treatment at the time their samples were collected (9, 6.3%).…”

In-vitro antibacterial activity of Pterolobium stellatum leaves extract against selected standard bacteria

“…Furthermore, natural products, either pure compounds or as standardized plant extracts, provide unlimited opportunities for new drug leads because of the unmatched availability of chemical diversity (Chakraborty, 2009;Meenakumari et al, 2011;Idris and Abubakar, 2016). This has urged microbiologists all over the world for formulation of new antimicrobial agents and evaluation of the efficacy of natural plant products as a substitute for chemical antimicrobial agents (Alikhan et al, 2012;Alfatah et al, 2013;Mimura et al, 2020).…”

Coexistence of blaTEM, blaCTX, blaKPC, blaNDM, blaSIM e blaOXA-48 in polymicrobial bloodstream isolates from a patient with acute myeloid leukemia

“…Infections in the bloodstream of patients with haematological neoplasia have often been caused by Klebsiella pneumoniae Carbapenemase (KPC) (Pagano et al, 2014), Pseudomonas aeruginosa (Tofas et al, 2017) and Acinetobacter baumannii (Shargian-Alon et al, 2019), as described in our study. Resistance to β-lactams and carbapenemases has been reported in these patients (Mimura et al, 2020).…”