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J Infect. 2014 Apr;68(4):321-31. doi: 10.1016/j.jinf.2013.12.006. Epub 2013 Dec 24.

Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients.

Author information

1
Division of Infectious Diseases, San Martino Hospital, University of Genoa, Largo R. Benzi 10, 16132 Genoa, Italy. Electronic address: m.mikulska@unige.it.
2
Division of Infectious Diseases, San Martino Hospital, University of Genoa, Largo R. Benzi 10, 16132 Genoa, Italy.
3
Infectious Diseases Service, Department of Medicine, BH-10-55, Centre Hospitalier Universitaire Vaudois, Rue du Bugon 46, CH-1011 Lausanne, Switzerland.
4
Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
5
Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
6
APHP-Henri Mondor, Hematology Department and Université Paris Est, LIC EA4393, F-94010 Créteil, France.
7
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara 06100, Turkey.

Abstract

OBJECTIVES:

A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients.

METHODS:

A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres.

RESULTS:

For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15-24%), aminoglycoside-resistant Gram-negatives (5-14%) and carbapenem-resistant P. aeruginosa (5-14%) were substantial, and significantly higher in South-East vs. North-West Europe.

CONCLUSIONS:

The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy.

KEYWORDS:

Antimicrobial resistance; Bloodstream infection; Cancer; Multidrug resistant (MDR) bacteria; Sepsis; Transplantation

PMID:
24370562
DOI:
10.1016/j.jinf.2013.12.006
[Indexed for MEDLINE]

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