Title |
Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group.
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Published in |
Clinical Infectious Diseases, July 2017
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DOI | 10.1093/cid/cix646 |
Pubmed ID | |
Authors |
Diana Averbuch, Gloria Tridello, Jennifer Hoek, Malgorzata Mikulska, Hamdi Akan, Lucrecia Yanez San Segundo, Thomas Pabst, Tülay Özçelik, Galina Klyasova, Irene Donnini, Depei Wu, Zafer Gülbas, Tsila Zuckerman, Aida Botelho de Sousa, Yves Beguin, Aliénor Xhaard, Emmanuel Bachy, Per Ljungman, Rafael de la Camara, Jelena Rascon, Isabel Ruiz Camps, Antonin Vitek, Francesca Patriarca, Laura Cudillo, Radovan Vrhovac, Peter J Shaw, Tom Wolfs, Tracey O'Brien, Batia Avni, Gerda Silling, Firas Al Sabty, Stelios Graphakos, Marja Sankelo, Henrik Sengeloev, Srinivas Pillai, Susanne Matthes, Frederiki Melanthiou, Simona Iacobelli, Jan Styczynski, Dan Engelhard, Simone Cesaro |
Abstract |
This intercontinental study aimed to study Gram-negative rods (GNR) resistance in hematopoietic stem cell transplantation (HSCT). 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). 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. 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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 5 | 15% |
United Kingdom | 4 | 12% |
Saudi Arabia | 2 | 6% |
Australia | 2 | 6% |
France | 1 | 3% |
Chile | 1 | 3% |
Colombia | 1 | 3% |
Switzerland | 1 | 3% |
Bolivia, Plurinational State of | 1 | 3% |
Other | 4 | 12% |
Unknown | 12 | 35% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 17 | 50% |
Scientists | 9 | 26% |
Practitioners (doctors, other healthcare professionals) | 7 | 21% |
Science communicators (journalists, bloggers, editors) | 1 | 3% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 204 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 25 | 12% |
Other | 22 | 11% |
Student > Postgraduate | 20 | 10% |
Student > Doctoral Student | 16 | 8% |
Student > Master | 16 | 8% |
Other | 49 | 24% |
Unknown | 56 | 27% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 84 | 41% |
Nursing and Health Professions | 9 | 4% |
Biochemistry, Genetics and Molecular Biology | 8 | 4% |
Agricultural and Biological Sciences | 6 | 3% |
Pharmacology, Toxicology and Pharmaceutical Science | 5 | 2% |
Other | 19 | 9% |
Unknown | 73 | 36% |