Bacteremia in Patients with Hematological Malignancies

Abstract

Background: An appropriate regimen in the empirical therapy of neutropenic fever episodes must be individualized at each institution. Hospitals have different patterns of microbial isolates and antibiotic resistance that must be taken into account. The aim of this study was to investigate isolates of bacteremia and their antibiotic susceptibility in patients with hematological malignancies. Methods: All positive blood cultures at a medical center in Taiwan between 1999 and 2002 from patients with hematological malignancies were evaluated. Eleven kinds of antibiotics were tested for antimicrobial activities. The risk factors for mortality were evaluated. Results: Three hundred seventy-one episodes of bacteremia in 266 patients with hematological malignancies were recorded. Gram-negative bacilli (GNB) were still predominant and accounted for 78.2% of isolates, followed by gram-positive cocci for 20.8% of isolates, and anaerobes for 1% of isolates. Escherichia coli was the most common isolated organism accounting for 27.5% of GNB isolates. Other isolates included Klebsiella pneumoniae (19.3%), Pseudomonas aeruginosa (11%), and Enterobacter cloacae (10.1%). The most isolated microorganisms were susceptible to cefoperazone/sulbactam, piperacillin/tazobactam, cefepime or imipenem. Age, GNB microorganism and inadequate empirical antibiotics were risk factors. Conclusions: We suggest that cefoperazone/sulbactam, piperacillin/tazobactam, cefepime or imipenem is an ideal empirical therapy.

Enterobacter Bacteremia: Clinical Features, Risk Factors for Multiresistance and Mortality in a Chinese University Hospital

“…Infection mortality was higher in the group with inadequate empirical therapy group than in the adequate therapy group. These findings were in accord with some studies [11,17,18]. The statistical difference between the crude mortality and infection mortality was probably due to the condition of patients at onset of symptoms and clinical features.…”

Antimicrobial susceptibility of bacteremic isolates from cancer patients with or without neutropenia at a medical center in southern Taiwan

“…The predominant etiology of BSIs in cancer patients with neutropenia has been reported to be gram-positive organisms in recent studies. 16e18 However, previous studies in Taiwan 6,19 and our data showed that GNB remain being responsible for most causative microorganisms of BSIs in cancer patients who were neutropenic or not. A high prevalence of Enterobacteriaceae bacteremia in neutropenic cancer patients with BSIs, at least 51.4%, may be explained by breaking down of gastrointestinal mucosal barrier.…”

Non-typhoidal Salmonella bacteremia among adults: An adverse prognosis in patients with malignancy

“…21 Whether underlying malignancy adversely affects the clinical outcome of patients with bacteremia is controversial. In a study of K pneumoniae bacteremia, malignancy served as an independent variable for mortality.…”