Should to all patients with febrile neutropenia and colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae carbapenems be appointed?

Охмат, В А; Клясова, Г А; Коробова, А Г; Паровичникова, Е Н; Fedorova, A.V.; Троицкая, В В; Грибанова, Е О; Савченко, В Г

doi:10.17650/1818-8346-2016-11-3-49-57

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Так, по результатам проспективного исследования, проведенного в нашем центре с апреля 2013 г. по июнь 2014 г., колонизация слизистой оболочки кишечника БЛРС-положительными энтеробактериями определялась у 26 (27 %) из 98 больных ОМЛ и лимфомами при первой госпитализации в наш центр, а при выпол-нении химиотерапии этот показатель достигал 80 % [11]. Частота бактериемии, вызванной идентичными по виду микроорганизмами, колонизирующими слизистую оболочку кишечника, составила всего 7,5 % (5 из 68 случаев) [12]. Явно возникает вопрос как о целесообразности назначения антибиотика из группы карбапенемов всем больным с фебрильной нейтропенией и колонизацией слизистой кишечника БЛРС-продуцирующими бактериями, так и о возмож-ности использования альтернативных антибиотиков в подобных ситуациях.…”

Section: Discussionunclassified

Antibiotic Treatment of Febrile Neutropenia in Patients with Acute Leukemia

Охмат¹,

Klyasova²,

Паровичникова³

et al. 2018

Клиническая онкогематология

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Aim. To estimate the efficacy of antibiotic treatment of febrile neutropenia in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Materials & Methods. The prospective study (2013 to 2015) included 66 AML and 44 ALL patients receiving 480 chemotherapy cycles within the period of 6 months. Results. Febrile neutropenia was registered during 242 (50 %) chemotherapy cycles occurring more frequently in AML than in ALL patients (93 % vs. 18 %, p < 0.0001). In AML patients infections were more common during induction and consolidation (98 and 89 %) phases compared to ALL patients who most commonly had infection during induction phase (55 %). Compared to ALL patients, AML patients had lower recovery rates after first-line antibiotic monotherapy (24 % vs. 57 %, p < 0.0001), compared to combination therapy (37 % vs. 18 %, p = 0.01). The use of beta-lactam antibiotics in ALL patients was associated with lower recovery rates during the induction phase compared to consolidation phase (47 % vs. 72 %, p = 0.0004). In cases of granulocytopaenia longer that 14 days the clinical recovery rate with administration of the first-line antibiotics and carbapenems accounted for 23-24 % compared to 47 % with other antimicrobials, more commonly with antifungal (21 %) administration. In patients with fever of unknown origin the monotherapy with first-line antibiotics proved to be successful (45 %). In patients with clinically and microbiologically defined infections the best results were achieved by the combined treatment with the beta-lactam antibiotics and other drugs (43 %). Conclusion. Antibiotic escalation has proved to be the optimal strategy in treatment of ALL patients and in cases of fever of unknown origin. The efficacy of the beta-lactam antibiotic monotherapy was lower in AML patients during the induction phase as well as in cases of continuous neutropenia (> 14 days) and clinically and microbiologically diagnosed infections. The adding of other antimicrobial administration resulted in the recovery in 37-48 % of cases.

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Section: Discussionunclassified

Antibiotic Treatment of Febrile Neutropenia in Patients with Acute Leukemia

Охмат¹,

Klyasova²,

Паровичникова³

et al. 2018

Клиническая онкогематология

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“…Одним из основных предикторов развития инфекций, вызванных БЛРС-положительными энтеробактериями, является колонизация слизистой оболочки кишечника этими бактериями [2]. При анализе 173 эпизодов инфекции, возникших у больных острыми миелоидными лейкозами (ОМЛ), было выявлено, что бактериемию, вызванную продуцентами БЛРС, диагностировали только у больных с колонизацией слизистой оболочки кишечника данными микроорганизмами с частотой 7,3 %, и не было случаев бактериемии у больных без колонизации [3]. Вероятность детекции БЛРС-положительных бактерий со слизистой оболочки кишечника в течение первых 6 мес цитостатической терапии достигала 91 % у больных ОМЛ и 84 % у больных лимфомами [4].…”

Section: проблемы инфекций в онкогематологииunclassified

Molecular characterization of extended-spectrum β-lactamase-producing <i>Escherichia coli</i> collected from patients with hematological malignancies during chemotherapy cycles

et al. 2019

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Objective: to evaluate the genetic relatedness of extended-spectrum β-lactamase (ESBL) producing Escherichia coli isolated from the gut in patients with acute myeloid leukemia and lymphoma at admission and during chemotherapy cycles. Materials and methods. The prospective study (2013–2014) included 73 patients (median age 39 years) with acute myeloid leukemia (n = 25) and lymphoma (n = 48). The follow-up period lasted for 96 days. ESBL-producing E. coli isolated from the gut were included in this study. ESBL-production was confirmed by phenotypic tests, blaCTX-M and blaTEM genes were detected by polymerase chain reaction, and genotyping was performed by ERIC (Enterobacterial Repetitive Intergenic Consensus) polymerase chain reaction. Results. ESBL-producing E. coli were detected in 39 (53 %) of 73 patients: of them 12 (16 %) patients were colonized at admission and 27 (37 %) patients – during chemotherapy cycles. Gene blaCTX-M was detected in 67 % of E. coli, blaTEM – in 41 %, both genes – in 26 %. There was no genetically related ESBL-producing E. coli among 12 isolates detected at admission. Genetic relatedness was detected in 16 (59 %) of 27 isolates obtained during a hospital stay. Genetically related ESBL-producing E. coli were isolated from patients hospitalized in the same and different departments, these isolates were characterized by the presence of both identical and various determinants of resistance. Conclusion. Our data demonstrated the possibility of patient-to-patient transmission of ESBL-producing E. coli isolated from the gut during a hospital stay.

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Should to all patients with febrile neutropenia and colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae carbapenems be appointed?

Cited by 2 publications

References 11 publications

Antibiotic Treatment of Febrile Neutropenia in Patients with Acute Leukemia

Antibiotic Treatment of Febrile Neutropenia in Patients with Acute Leukemia

Molecular characterization of extended-spectrum β-lactamase-producing <i>Escherichia coli</i> collected from patients with hematological malignancies during chemotherapy cycles

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