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
Language English Country United States Media print
Document type Journal Article
PubMed
29020364
DOI
10.1093/cid/cix646
PII: 4036247
Knihovny.cz E-resources
- Keywords
- antimicrobial resistance, bacteremia, gram-negative rods, hematopoietic stem cell transplantation,
- MeSH
- Anti-Bacterial Agents pharmacology therapeutic use MeSH
- Bacteremia drug therapy epidemiology microbiology MeSH
- Child MeSH
- Adult MeSH
- Gram-Negative Bacterial Infections drug therapy epidemiology microbiology MeSH
- Gram-Negative Bacteria drug effects MeSH
- Internationality MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Drug Resistance, Multiple, Bacterial * MeSH
- Child, Preschool MeSH
- Transplant Recipients * statistics & numerical data MeSH
- Prospective Studies MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Hematopoietic Stem Cell Transplantation * MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe epidemiology MeSH
- Names of Substances
- Anti-Bacterial Agents MeSH
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
References provided by Crossref.org
ClinicalTrials.gov
NCT02257931
