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Resistance to empirical β-lactams recommended in febrile neutropenia guidelines in Gram-negative bacilli bloodstream infections in Spain: a multicentre study.
- Source :
- Journal of Antimicrobial Chemotherapy (JAC); Jul2022, Vol. 77 Issue 7, p2017-2023, 7p
- Publication Year :
- 2022
-
Abstract
- <bold>Objectives: </bold>To describe current resistance to the β-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB).<bold>Methods: </bold>Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated.<bold>Results: </bold>Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three β-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT.<bold>Conclusions: </bold>Current resistance to empirical β-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTIBIOTICS
BACTEREMIA
RESEARCH
BETA lactam antibiotics
GRAM-negative bacteria
RESEARCH methodology
NEUTROPENIA
RETROSPECTIVE studies
EVALUATION research
SEPSIS
COMPARATIVE studies
IMPACT of Event Scale
RESEARCH funding
GRAM-negative bacterial diseases
PSEUDOMONAS
BRIEF Symptom Inventory
LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 03057453
- Volume :
- 77
- Issue :
- 7
- Database :
- Complementary Index
- Journal :
- Journal of Antimicrobial Chemotherapy (JAC)
- Publication Type :
- Academic Journal
- Accession number :
- 157803418
- Full Text :
- https://doi.org/10.1093/jac/dkac135