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| Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 Jul 26. pii: 4036247. doi: 10.1093/cid/cix646 |
| Antimicrobial resistance in Gram-negative rods causing bacteremia in hematopoietic stem cell transplant patients: intercontinental prospective study of Infectious Diseases Working Party of the European Bone Marrow Transplantation group. |
| Averbuch D1, Tridello G2, Hoek J3, Mikulska M4, Akan H5, Yanez San Segundo L6, Pabst T7, Özçelik T8, Klyasova G9, Donnini I10, Wu D11, Gülbas Z12, Zuckerman T13, Botelho de Sousa A14, Beguin Y15, Xhaard A16, Bachy E17, Ljungman P18, de la Camara R19, Rascon J20, Ruiz Camps I21, Vitek A22, Patriarca F23, Cudillo L24, Vrhovac R25, Shaw PJ26, Wolfs T27, O'Brien T28, Avni B29, Silling G30, Al Sabty F31, Graphakos S32, Sankelo M33, Sengeloev H34, Pillai S35, Matthes S36, Melanthiou F37, Iacobelli S38, Styczynski J39, Engelhard D40, Cesaro S41 |
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Abstract BACKGROUND: This intercontinental study aimed to study Gram-negative rods (GNR) resistance in hematopoietic stem cell transplantation (HSCT). METHODS: GNR bacteremias occurring during six months post-HSCT (February/2014-May/2015) were prospectively collected, and analysed for rates and risk factors for resistance to fluoroquinolones, non-carbapenem anti-Pseudomonas beta-lactams (non-carbapenems), carbapenems and multidrug-resistance (MDR). RESULTS: Sixty-five HSCT centers from 25 countries (Europe, Australia, Asia) reported data on 655 GNR episodes/704 pathogens in 591 patients (Enterobacteriaceae, 73%; non-fermentatives, 24% and 3% others). Half GNR were fluoroquinolone- and non-carbapenems-resistant; 18.5% carbapenem-resistant; 35.2% MDR. The total resistance rates were higher in allo-HSCT vs. auto-HSCT patients (p<0.001); but similar in community-acquired infections. Non-carbapenems-resistance and MDR were higher in auto-HSCT patients in centers providing vs. non-providing fluoroquinolone prophylaxis (p<0.01). Resistance rates were higher in southeast vs. north-west Europe; similar in children and adults; excluding higher fluoroquinolone- and beta-lactam beta-lactamase inhibitors-resistance rates in allo-HSCT adults. Non-Klebsiella Enterobacteriaceae were rarely carbapenem-resistant. Multivariable analysis revealed resistance risk factors in allo-HSCT patients: fluoroquinolone-resistance: adult, prolonged neutropenia, breakthrough on fluoroquinolones; non-carbapenems-resistance: hospital-acquired infection, breakthrough on non-carbapenems or other antibiotics (excluding fluoroquinolones, non-carbapenems, carbapenems), donor type; carbapenem-resistance: breakthrough on carbapenem, longer hospitalization, intensive care unit, previous other antibiotic therapy; MDR: longer hospitalization, breakthrough on beta-lactam beta-lactamase inhibitors and carbapenems. Inappropriate empirical therapy and mortality were significantly more common in infections caused by resistant bacteria. CONCLUSION: Our data question the recommendation for fluoroquinolone prophylaxis and call for reassessment of local empirical antibiotic protocols. Knowledge of pathogen-specific resistances enable early appropriate empirical therapy. Monitoring of resistance is crucial. |
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KEYWORDS: Antimicrobial resistance, Bacteremia, Gram-negative rods, Hematopoietic stem cell transplantation |
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Publikations ID: 29020364 Quelle: öffnen |
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