Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case-controlled study

Špánik, S.; Novotný, Jozef; Mateicka, F.; Pichnova, E.; Sulcová, M; Jurga, L; Sabo, Alex N.; Krčméry, V.; Krupova, I.; Trupl, J.; Kunová, A.

doi:10.1007/s101560050031

Cited by 26 publications

(9 citation statements)

References 7 publications

(10 reference statements)

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“…This finding is consistent with those of recent studies that reported an increase in antibiotic resistance among gram-negative bacilli worldwide. 13 , 19 , 22 , 25 , 28 …”

Section: Discussionmentioning

confidence: 99%

Bloodstream Infections in Patients With Solid Tumors

et al. 2014

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Current information regarding bloodstream infection (BSI) in patients with solid tumors is scarce. We assessed the epidemiology, antibiotic therapy, and outcomes of BSI in these patients. We also compared patients who died with those who survived to identify risk factors associated with mortality. From January 2006 to July 2012 all episodes of BSI in patients with solid tumors at a cancer center were prospectively recorded and analyzed. A total of 528 episodes of BSI were documented in 489 patients. The most frequent neoplasms were hepatobiliary tumors (19%), followed by lung cancer (18%) and lower gastrointestinal malignancies (16%). Many patients had received corticosteroid therapy (41%), and 15% had neutropenia (<500 neutrophils/μL) at the time of BSI. The most common source of BSI was cholangitis (21%), followed by other abdominal (19.5%) and urinary tract infections (17%). Gram-negative BSI occurred in 55% of cases, mainly due to Escherichia coli (55%), Pseudomonas aeruginosa (18%), and Klebsiella pneumoniae (16%). Among gram-positive BSI (35%), viridans group streptococci were the most frequent causative organisms (22%), followed by Staphylococcus aureus (21%) and Enterococcus species (18%). We identified 61 multidrug-resistant (MDR) organisms (13%), mainly extended-spectrum β-lactamase-producing Enterobacteriaceae (n = 20) and AmpC-producing Enterobacteriaceae (n = 13). The majority of patients with BSI caused by MDR organisms had received antibiotics (70%), and they had been previously hospitalized (61.4%) more frequently than patients with BSI caused by susceptible strains. Inadequate empirical antibiotic therapy was given to 23% of patients, with a higher proportion in those with BSI due to a MDR strain (69%). Early (<48 h) and overall (30 d) case-fatality rates were 7% and 32%, respectively. The overall case-fatality rate was higher among cases caused by MDR organisms (39.3%). The only independent risk factors for the early case-fatality rate were the endogenous source of BSI (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.06–12.02), shock at presentation (OR, 3.63; 95% CI, 1.63–8.09), and corticosteroid therapy (OR, 3.245; 95% CI, 1.43–7.32). The independent risk factors for overall case-fatality rate were the presence of a chronic advanced cancer (OR, 35.39; 95% CI, 2.48–504.91), shock at presentation (OR, 25.84; 95% CI, 3.73–179.0), and corticosteroid therapy (OR, 6.98; 95% CI, 1.61–30.21).BSI in patients with solid tumors occurred mainly among those with hepatobiliary cancer, and cholangitis was the most frequent source; gram-negative bacilli were the most frequent causative agents. MDR organisms were relatively common, particularly in patients who had previously received antibiotics and had been hospitalized; these patients were frequently treated with inadequate empirical antibiotic therapy and had a poorer outcome. The case-fatality rate of patients with solid tumors and BSI was high and was associated with chronic advanced cancer, corticosteroid therapy, and shock at presentation.

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“…This finding is consistent with those of recent studies that reported an increase in antibiotic resistance among gram-negative bacilli worldwide. 13 , 19 , 22 , 25 , 28 …”

Section: Discussionmentioning

confidence: 99%

Bloodstream Infections in Patients With Solid Tumors

et al. 2014

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“…The use of antimicrobials has been found to be related with acquisition of multi-resistant pathogens in similar studies. Spanik et al 26 reported a higher incidence of MDR Gramnegative infections in neutropenic cancer patients who received third-generation cephalosporins as prophylaxis (41.2 vs 13.7%, Po0.01). The authors also reported that previous use of quinolones and other broad-spectrum antibiotics (second generation cephalosporins, aminoglycosides and imipenem) were more frequently associated with MDR Gram-negative infections.…”

Section: S R Nt S R Nt S R Nt S R Nt S R Nt S R Ntmentioning

confidence: 98%

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Oliveira

Souza

Carvalho-Dias

et al. 2007

Bone Marrow Transplant

151

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The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third-or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3. 75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.

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“…Additionally, several studies have identified prior antimicrobial exposure as a risk factor for antibiotic-resistant Gram-negative bacteremia among cancer patients (Garnica et al, 2009; Oliveira et al, 2007; Spanik et al, 1999; Vigil et al, 2009). Identifying risk factors for antibiotic-resistant Gram-negative bacteremia may guide empiric antibiotic therapy and thus improve outcomes among these patients.…”

Section: Introductionmentioning

confidence: 99%

Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

Hess

Kleinberg

Sorkin

et al. 2014

Diagnostic Microbiology and Infectious Disease

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We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2–365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5–14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3–4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.

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Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case-controlled study

Cited by 26 publications

References 7 publications

Bloodstream Infections in Patients With Solid Tumors

Bloodstream Infections in Patients With Solid Tumors

Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients

Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

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