Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study

Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative pathogens to third-generation cephalosporins is increasing. We aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 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 third-generation cephalosporin resistant Gram-negative bacteria (3GC-R GNB) in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization (identified using surveillance cultures) in the year before. Results We included 3,887 patients, representing 4,142 episodes of bacteraemia. GNB were identified in 715/4,142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In (106/139) 76.2% of patients with a 3GC-R GNB bacteraemia and available GNB surveillance cultures in the preceding year, 3GC-R GNB colonization had been previously identified. 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 surveillance-culture guided empirical therapy to restrict the empirical use of carbapenems in this population.