OBJECTIVES: To assess the risk factors, antibiotic therapy and outcomes of multidrug-resistant Gram-negative bacilli (MDRGNB) bacteraemia in hospitalized patients with cancer. METHODS: Episodes of MDRGNB bacteraemia were compared with a susceptible control group in a 4 year prospective study. RESULTS: Of 747 bacteraemias, 372 (49.7%) were caused by a Gram-negative bacilli (GNB). Fifty-one of these (13.7%) were caused by a multidrug-resistant (MDR) strain. Previous antibiotics [odds ratio (OR) 3.57; 95% confidence interval (CI) 1.63-7.80] and urinary catheter (OR 2.41; 95% CI 1.01-5.74) were identified as independent risk factors for MDRGNB acquisition. The most frequent mechanism of resistance was extended-spectrum β-lactamase (ESBL) production (45%), mainly by Escherichia coli, followed by Amp-C cephalosporinase hyperproduction (24%). Patients with MDRGNB bacteraemia more frequently received inadequate initial antibiotic therapy (69% versus 9%; P < 0.001) and time to adequate therapy was longer in this group (41% versus 4%; P < 0.001). Patients in the resistant group more frequently required intensive care unit (ICU) admission (14% versus 5%; P = 0.023), had greater need for mechanical ventilation (14% versus 3%; P = 0.005) and had a higher overall case-fatality rate (41% versus 21%; P = 0.003). Risk factors for mortality were solid tumour (OR 5.04; 95% CI 2.49-10.19), current corticosteroid use (OR 4.38; 95% CI 2.39-8.05), ICU admission (OR 11.40; 95% CI 3.19-40.74) and MDRGNB bacteraemia (OR 3.52; 95% CI 1.36-9.09). CONCLUSIONS: MDRGNB bacteraemia was common among cancer patients, especially in those exposed to antibiotics and urinary catheter. The most frequent mechanism of resistance was ESBL production. Patients with MDRGNB more frequently received inadequate empirical antibiotic therapy and presented poorer outcomes with a higher overall case-fatality rate (within 30 days).
OBJECTIVES: To assess the risk factors, antibiotic therapy and outcomes of multidrug-resistant Gram-negative bacilli (MDRGNB) bacteraemia in hospitalized patients with cancer. METHODS: Episodes of MDRGNB bacteraemia were compared with a susceptible control group in a 4 year prospective study. RESULTS: Of 747 bacteraemias, 372 (49.7%) were caused by a Gram-negative bacilli (GNB). Fifty-one of these (13.7%) were caused by a multidrug-resistant (MDR) strain. Previous antibiotics [odds ratio (OR) 3.57; 95% confidence interval (CI) 1.63-7.80] and urinary catheter (OR 2.41; 95% CI 1.01-5.74) were identified as independent risk factors for MDRGNB acquisition. The most frequent mechanism of resistance was extended-spectrum β-lactamase (ESBL) production (45%), mainly by Escherichia coli, followed by Amp-C cephalosporinase hyperproduction (24%). Patients with MDRGNB bacteraemia more frequently received inadequate initial antibiotic therapy (69% versus 9%; P < 0.001) and time to adequate therapy was longer in this group (41% versus 4%; P < 0.001). Patients in the resistant group more frequently required intensive care unit (ICU) admission (14% versus 5%; P = 0.023), had greater need for mechanical ventilation (14% versus 3%; P = 0.005) and had a higher overall case-fatality rate (41% versus 21%; P = 0.003). Risk factors for mortality were solid tumour (OR 5.04; 95% CI 2.49-10.19), current corticosteroid use (OR 4.38; 95% CI 2.39-8.05), ICU admission (OR 11.40; 95% CI 3.19-40.74) and MDRGNB bacteraemia (OR 3.52; 95% CI 1.36-9.09). CONCLUSIONS:MDRGNB bacteraemia was common among cancerpatients, especially in those exposed to antibiotics and urinary catheter. The most frequent mechanism of resistance was ESBL production. Patients with MDRGNB more frequently received inadequate empirical antibiotic therapy and presented poorer outcomes with a higher overall case-fatality rate (within 30 days).
Authors: Frauke Mattner; Franz-C Bange; Elisabeth Meyer; Harald Seifert; Thomas A Wichelhaus; Iris F Chaberny Journal: Dtsch Arztebl Int Date: 2012-01-20 Impact factor: 5.594
Authors: Marta Bodro; Carlota Gudiol; Carolina Garcia-Vidal; Fe Tubau; Anna Contra; Lucía Boix; Eva Domingo-Domenech; Mariona Calvo; Jordi Carratalà Journal: Support Care Cancer Date: 2013-10-30 Impact factor: 3.603
Authors: Margaret A Fitzpatrick; Katie J Suda; Nasia Safdar; Stephen P Burns; Makoto M Jones; Linda Poggensee; Swetha Ramanathan; Charlesnika T Evans Journal: J Spinal Cord Med Date: 2017-02-15 Impact factor: 1.985
Authors: D Averbuch; E Horwitz; J Strahilevitz; P Stepensky; N Goldschmidt; M E Gatt; M Y Shapira; I B Resnick; D Engelhard Journal: Infection Date: 2013-05-08 Impact factor: 3.553
Authors: Diana Averbuch; Christina Orasch; Catherine Cordonnier; David M Livermore; Malgorzata Mikulska; Claudio Viscoli; Inge C Gyssens; Winfried V Kern; Galina Klyasova; Oscar Marchetti; Dan Engelhard; Murat Akova Journal: Haematologica Date: 2013-12 Impact factor: 9.941
Authors: C Gudiol; A Albasanz-Puig; J Laporte-Amargós; N Pallarès; A Mussetti; I Ruiz-Camps; P Puerta-Alcalde; E Abdala; C Oltolini; M Akova; M Montejo; M Mikulska; P Martín-Dávila; F Herrera; O Gasch; L Drgona; H Paz Morales; A-S Brunel; E García; B Isler; W V Kern; I Morales; G Maestro-de la Calle; M Montero; S S Kanj; O R Sipahi; S Calik; I Márquez-Gómez; J I Marin; M Z R Gomes; P Hemmatti; R Araos; M Peghin; J L Del Pozo; L Yáñez; R Tilley; A Manzur; A Novo; J Carratalà Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191