Risk Factors and Scoring System for Predicting Bacterial Resistance to Cefepime as Used Empirically in Haematology Wards

Abstract

Objectives. Bacterial resistance is of growing concern in haematology wards. As the inappropriate administration of empirical antibacterial may alter survival, we studied risk factors for resistance to our usual empirical first-line antibacterial therapy, cefepime. Methods. We retrospectively studied 103 first episodes of bacteraemia recorded in our haematology department over 2.5 years. Risk factors for cefepime-resistance were identified by multivariate logistic regression with backward selection (P < 0.05). A scoring system for predicting cefepime-resistance was built on independent factor, with an internal validation by the bootstrap resampling technique. Results. 38 (37%) episodes were due to Gram-negative bacteria. Fifty (49%) were due to bacteria resistant to cefepime. Cefepime resistance was significantly associated with a decreased survival at day 30 (P < 0.05). Three risk factors were independently associated with cefepime-resistance: acute lymphoblastic leukaemia; ≥18 days since hospital admission; and receipt of any β-lactam in the last month. Patients with ≥2 of these risk factors had a probability of 86% (CI 95%, 25 to 100%) to carry a cefepime-resistant strain. Conclusion. Using our scoring system should reduce the indication of very broad antibacterial regimens in the empirical, first-line treatment of febrile hematology patients in more than 80% of the cases.

Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients

“…Recent antibiotic exposure before the episode of bacteremia has also been described as a risk factor for MDR GNR in multiple studies, 4 , 28 , 38 with third and fourth generation cephalosporins, fluoroquinolones and carbapenems being the most implicated agents. 9 , 18 , 28 , 35 …”

“…That is also the case for recent hospitalization in an intensive care unit. 4 , 9 , 17 , 18 , 35 , 38 …”

“…Among patients with hematological malignancies, a retrospective study carried out in France 18 evaluated the risk factors for cefepime resistance. Recent hospitalization, previous use of antibiotics and acute lymphoblastic leukemia proved to be associated with infections with cefepime resistant bacteria, thus proposing a score with these three variables.…”

“…Multiple studies have outlined the risk factors for MDR GNR. 4 , 16 , 17 , 18 However, no clinical score has been designed to include both cancer patients with GNR bacteremia and local data. Furthermore, different incidence, resistance patterns and risk factors associated with MDR GNR have been reported worldwide due to the current changes in epidemiology.…”

Detection of diabetic macular oedema: validation of optical coherence tomography using both foveal thickness and intraretinal fluid

“…Finally, calculations were made of the sensitivity, specificity, and the positive (PLR) and negative (NLR) likelihood ratios. To validate the model, we performed 1,000 bootstrapping samples to calculate: sensitivity, specificity, PLR, NLR and AUC (El Maaroufi et al, 2015). The analyses were all done with a significance of 5% and the confidence interval (CI) was calculated for each relevant parameter.…”