Hematological: Low all‐cause mortality and low occurrence of antimicrobial resistance in hematological patients with bacteremia receiving no antibacterial prophylaxis: a single‐center study

Kjellander, Christian; Björkholm, Magnus; Cherif, Honar; Kalin, Mats; Giske, Christian G.

doi:10.1111/j.1600-0609.2012.01768.x

Cited by 36 publications

(31 citation statements)

References 40 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…45 On the other hand, there are still regions where resistant strains are infrequent and the mortality associated with BSIs remains low. 46 Therefore, a continuously updated knowledge of local epidemiology is crucial.…”

Section: Increase In Resistant Strainsmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

View full text Add to dashboard Cite

Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

show abstract

Section: Increase In Resistant Strainsmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

View full text Add to dashboard Cite

show abstract

“…Antimicrobial susceptibility testing was documented according to the CLSI in 16 studies 12,14,17,18,22,23,25,28,[31][32][33][35][36][37][38]40 and according to EUCAST or to Swedish Reference Group for Antibiotics (SRGA) breakpoints in two studies, 11,21 while for the others the testing method was not documented. Only two reports performed molecular characterization of CR strains.…”

Section: 39mentioning

confidence: 99%

“…11,13,19,22 Data on the outcome of CR BSIs in neutropenic patients were reported by 10 studies. 11,13,[15][16][17]19,21,22,30,32 Mortality rates ranged from 33.3% to 71.4% (median rates 50%). One study reporting only carbapenemase-producing Kp (KPC-Kp) BSIs Only Pseudomonas spp.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

View full text Add to dashboard Cite

Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

show abstract

“…Fluoroquinolone-resistance in strains causing BSI is to be expected, as fluoroquinolone prophylaxis is recommended and widely used during neutropenia [31,32] The rate of fluoroquinolone resistance in E. coli increased irrespectively of the use of prophylaxis [23,33] Given a global increase in fluoroquinolone resistance in Enterobacteriaceae, the benefit of fluoroquinolone prophylaxis nowadays in uncertain, as its efficacy is reduced when the prevalence of fluoroquinoloneresistant Gram-negative rods exceeds 20% [18 && ,34]…”

Section: Strategies For Management Of Bacterial Infection In Transplamentioning

confidence: 99%