Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients
Introduction
Appropriate empirical antibiotic therapy is critical to outcome in cases of fever among severely immunocompromised patients, such as those who are neutropenic, have haematological malignancies, or receive hematopoietic stem cell transplants (HSCT). Empirical treatment regimens typically include a beta-lactam, with or without an aminoglycoside, and they should be active against Gram-negative bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa.1 To provide the best empirical coverage, it is critical to have a good knowledge of general and local trends in infection aetiology and resistance patterns.
During the 1980s and early 1990s, the proportion of infections due to Gram-positive pathogens in neutropenic patients rose2, 3; subsequently this trend has been reversing in some centres, with Gram-negative pathogens again becoming relatively more prevalent.4, 5, 6 In haematology wards, as elsewhere, there is a significant increase in the proportion of infections caused by multidrug-resistant (MDR) bacteria, especially Gram-negative rods with extended-spectrum spectrum beta-lactamases (ESBLs). Some centres report increases in vancomycin-resistant enterococci (VRE).7, 8, 9
The present analysis sought to establish whether these shifts were widespread and explored the potential implications for empirical antibiotic regimens employed to manage fever arising during neutropenia.
Section snippets
Materials and methods
The study included a review of recently-published relevant literature data and a questionnaire sent to various hospitals, seeking information on their current aetiology and resistance patterns of bacteraemia in haematology and oncology patients.
Literature search
Overall, 847 articles were retrieved, 322 abstracts screened, and 95 manuscripts selected for further evaluation. Among these, 49 provided relevant data: 16 both on epidemiology and resistance, 29 only on epidemiology and 4 only on resistance. Data from 3 manuscripts including both adults and children were analysed together with other data for adults, whereas data on children only were analysed separately. Twelve (60%) of 20 papers reporting susceptibility data used CLSI interpretative criteria
Discussion
Surprisingly few up-to-date analyses of the aetiology and resistance patterns of bacteraemia pathogens are available for haematology/oncology patients. Although several single-centre retrospective analyses have been published in the last 10 years, many refer to isolates obtained earlier. Since then, the aetiology of bacteraemias in these centres may have changed, reflecting different management protocols. More importantly, changes in resistance patterns almost certainly have occurred with
Funding
The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck and Pfizer.
Conflict of interest
DML has shareholdings Dechra, Merck and Pfizer and has accepted grants, speaking invitations and conference invitations from Achaogen, Merck, Pfizer, Novartis, AstraZeneca and Astellas; he has advisory or consultancy relationships with Achaogen, Adenium, Allecra, BioVersys, AstraZeneca, Basilea, Bayer, Cubist, Curetis, Discuva, GlaxoSmithKline, Kalidex, McKinsey, Meiji, Pfizer, Roche, Tetraphase, Theravance and Wockhardt.
MA had grants and speaker fees from Gilead, Merck, Novartis and Pfizer.
Acknowledgements
The lists of the colleagues who dedicated their time and participated in the questionnaire survey and of all those who participated in the ECIL-4 meeting are reported in Supporting Information file.
The authors would like to thank Jean-Michel Gosset and the staff of KOBE, group GL Events, Lyon, France, for the organization of the meeting.
These results have been presented during the ECIL-4 meeting in Juan-les-Pins, France, Sept 9–10th 2011.
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