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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

D. Averbuch, G. Tridello, J. Hoek, M. Mikulska, H. Akan, L. Yanez San Segundo, T. Pabst, T. Özçelik, G. Klyasova, I. Donnini, D. Wu, Z. Gülbas, T. Zuckerman, A. Botelho de Sousa, Y. Beguin, A. Xhaard, E. Bachy, P. Ljungman, R. de la Camara, J....

. 2017 ; 65 (11) : 1819-1828.

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc18033672

Background: This intercontinental study aimed to study gram-negative rod (GNR) resistance in hematopoietic stem cell transplantation (HSCT). Methods: GNR bacteremias occurring during 6 months post-HSCT (February 2014-May 2015) were prospectively collected, and analyzed for rates and risk factors for resistance to fluoroquinolones, noncarbapenem anti-Pseudomonas β-lactams (noncarbapenems), carbapenems, and multidrug resistance. Results: Sixty-five HSCT centers from 25 countries in Europe, Australia, and Asia reported data on 655 GNR episodes and 704 pathogens in 591 patients (Enterobacteriaceae, 73%; nonfermentative rods, 24%; and 3% others). Half of GNRs were fluoroquinolone and noncarbapenem resistant; 18.5% carbapenem resistant; 35.2% multidrug resistant. The total resistance rates were higher in allogeneic HSCT (allo-HSCT) vs autologous HSCT (auto-HSCT) patients (P < .001) but similar in community-acquired infections. Noncarbapenem resistance and multidrug resistance were higher in auto-HSCT patients in centers providing vs not providing fluoroquinolone prophylaxis (P < .01). Resistance rates were higher in southeast vs northwest Europe and similar in children and adults, excluding higher fluoroquinolone- and β-lactam/β-lactamase inhibitor 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; noncarbapenem resistance: hospital-acquired infection, breakthrough on noncarbapenems or other antibiotics (excluding fluoroquinolones, noncarbapenems, carbapenems), donor type; carbapenem resistance: breakthrough on carbapenem, longer hospitalization, intensive care unit, previous other antibiotic therapy; multidrug resistance: longer hospitalization, breakthrough on β-lactam/β-lactamase inhibitors, and carbapenems. Inappropriate empiric therapy and mortality were significantly more common in infections caused by resistant bacteria. Conclusions: Our data question the recommendation for fluoroquinolone prophylaxis and call for reassessment of local empiric antibiotic protocols. Knowledge of pathogen-specific resistance enables early appropriate empiric therapy. Monitoring of resistance is crucial. Clinical Trials Registration: NCT02257931.

1st Affiliated Hospital of Soochow University Suzhou Jiangsu China

Anadolu Medical Center Hospital Kocaeli Turkey

Azienda Ospedaliera Universitaria Careggi Firenze Italy

Azienda Ospedaliero Universitaria Udine Italy

Centre Hospitalier Lyon Sud Hospices Civils de Lyon France

Collegium Medicum Nicolaus Copernicus University Torun Bydgoszcz Poland

European Bone Marrow Transplantation Data Office Leiden The Netherlands

Faculty of Medicine Ankara University Turkey

Florence Nightingale Sisli Hospital Istanbul Turkey

Hadassah University Hospital Jerusalem Israel

Hospital de la Princesa Madrid Spain

Hospital dos Capuchos Lisbon Portugal

Hospital St Louis Paris France

Hospital Universitario Marqués de Valdecilla Santander Spain

Hospital Vall d'Hebron Barcelona Spain

Institute of Hematology and Blood Transfusion Prague Czech Republic

Karolinska University Hospital and Karolinska Institute Stockholm Sweden

National Research Center for Hematology Moscow Russia

Nicosia General Hospital Nicosia Strovolos Cyprus

Ospedale San Martino Genova Italy

Pediatric Hematology Oncology Azienda Ospedaliera Universitaria Integrata Verona Italy

Rambam Medical Center Haifa Israel

Rigshospitalet Copenhagen Denmark

St Anna Kinderspital Vienna Austria

St Sophia Children's Hospital Athens Greece

Sydney Children's Hospital Randwick Australia

Tampere University Hospital Finland

The Children's Hospital at Westmead Sydney Australia

Tor Vergata University Rome Italy

University Hospital Bern Switzerland

University Hospital Bratislava Slovakia

University Hospital Center Rebro Zagreb Croatia

University Hospital for Children Utrecht The Netherlands

University Hospital of North Staffordshire Stoke United Kingdom

University Hospital Santariskiu Klinikos Vilnius Lithuania

University of Liege Belgium

University of Münster Germany

Citace poskytuje Crossref.org

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