1. Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study
- Author
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de la Court, Jara R., Woudt, Sjoukje H. S., Schoffelen, Annelot F., Heijmans, Jarom, de Jonge, Nick A., van der Bruggen, Tjomme, Bomers, Marije K., Lambregts, Merel M. C., Schade, Rogier P., Sigaloff, Kim C. E., Stuart, J. W. T. Cohen, Melles, D. C., van Dijk, K., Alzubaidy, A., Werdmuller, B. F. M., Blaauw, G. J., Diederen, B. M. W., Alblas, H. J., der Kuil, W. Altorf-van, Bierman, S. M., de Greeff, S. C., Groenendijk, S. R., Hertroys, R., Kuijper, E. J., Monen, J. C., Notermans, D. W., van den Reek, W. J., Smilde, A. E., Wielders, C. C. H., Zoetigheid, R. E., van den Bijllaardt, W., Kraan, E. M., Mattsson, E. E., da Silva, J. M., de Jong, E., Maraha, B., van Asselt, G. J., Demeulemeester, A., Wintermans, B. B., van Trijp, M., Ott, A., Sinnige, J., Silvis, W., Bakker, L. J., Dorigo-Zetsma, J. W., Waar, K., Bernards, A. T., Hall, M. A. Leversteijn-van, Schaftenaar, E., Nabuurs-Franssen, M. H., Wertheim, H., Bode, L., van Rijn, M., Dinant, S., Pontesilli, O., de Man, P., Wong, M., Muller, A. E., Renders, N. H., Bentvelsen, R. G., Buiting, A. G. M., Vlek, A. L. M., Stam, A. J., Troelstra, A., Overdevest, I. T. M. A., van Meer, M. P. A., dos Santos, C. Oliveira, Wolfhagen, M. J. H. M., Hematology, Internal medicine, AII - Infectious diseases, Medical Microbiology and Infection Prevention, APH - Quality of Care, Elderly care medicine, APH - Aging & Later Life, Graduate School, General Internal Medicine, CCA - Cancer biology and immunology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Clinical Haematology, Experimental Immunology, and APH - Health Behaviors & Chronic Diseases
- Subjects
Third-generation-cephalosporin resistance ,Colonization ,Microbiology (medical) ,Febrile neutropenia ,Bacteremia ,General Medicine ,Antimicrobial resistance ,Empirical antibiotic therapy ,Ceftazidime ,Infectious Diseases ,Carbapenems ,Hematologic Neoplasms ,Resistance surveillance ,Humans ,Prospective Studies ,Retrospective Studies - Abstract
Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization. Methods Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates). Results We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate. Conclusions This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.
- Published
- 2022
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