Format

Send to

Choose Destination
Clin Infect Dis. 2017 Nov 13;65(11):1819-1828. doi: 10.1093/cid/cix646.

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group.

Author information

1
Hadassah University Hospital, Jerusalem, Israel.
2
Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
3
European Bone Marrow Transplantation Data Office, Leiden, The Netherlands.
4
Ospedale San Martino, Genova, Italy.
5
Faculty of Medicine, Ankara University, Turkey.
6
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
7
University Hospital, Bern, Switzerland.
8
Florence Nightingale Sisli Hospital, Istanbul, Turkey.
9
National Research Center for Hematology, Moscow, Russia.
10
Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
11
First Affiliated Hospital of Soochow University, Suzhou Jiangsu, China.
12
Anadolu Medical Center Hospital, Kocaeli, Turkey.
13
Rambam Medical Center, Haifa, Israel.
14
Hospital dos Capuchos, Lisbon, Portugal.
15
University of Liege, Belgium.
16
Hospital St Louis, Paris, France.
17
Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France.
18
Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
19
Hospital de la Princesa, Madrid, Spain.
20
University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
21
Hospital Vall d'Hebron, Barcelona, Spain.
22
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
23
Azienda Ospedaliero Universitaria, Udine, Italy.
24
Tor Vergata University, Rome, Italy.
25
University Hospital Center Rebro, Zagreb, Croatia.
26
The Children's Hospital at Westmead, Sydney, Australia.
27
University Hospital for Children, Utrecht, The Netherlands.
28
Sydney Children's Hospital, Randwick, Australia.
29
University of Münster, Germany.
30
University Hospital, Bratislava, Slovakia.
31
St Sophia Children's Hospital, Athens, Greece.
32
Tampere University Hospital, Finland.
33
Rigshospitalet, Copenhagen, Denmark.
34
University Hospital of North Staffordshire, Stoke, United Kingdom.
35
St Anna Kinderspital, Vienna, Austria.
36
Nicosia General Hospital, Nicosia Strovolos, Cyprus.
37
Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.

Abstract

Background:

This intercontinental study aimed to study gram-negative rod (GNR) resistance in hematopoietic stem cell transplantation (HSCT).

Methods:

GNR bacteremias occurring during 6 months post-HSCT (February 2014-May 2015) were prospectively collected, and analyzed for rates and risk factors for resistance to fluoroquinolones, noncarbapenem anti-Pseudomonas β-lactams (noncarbapenems), carbapenems, and multidrug resistance.

Results:

Sixty-five HSCT centers from 25 countries in Europe, Australia, and Asia reported data on 655 GNR episodes and 704 pathogens in 591 patients (Enterobacteriaceae, 73%; nonfermentative rods, 24%; and 3% others). Half of GNRs were fluoroquinolone and noncarbapenem resistant; 18.5% carbapenem resistant; 35.2% multidrug resistant. The total resistance rates were higher in allogeneic HSCT (allo-HSCT) vs autologous HSCT (auto-HSCT) patients (P < .001) but similar in community-acquired infections. Noncarbapenem resistance and multidrug resistance were higher in auto-HSCT patients in centers providing vs not providing fluoroquinolone prophylaxis (P < .01). Resistance rates were higher in southeast vs northwest Europe and similar in children and adults, excluding higher fluoroquinolone- and β-lactam/β-lactamase inhibitor resistance rates in allo-HSCT adults. Non-Klebsiella Enterobacteriaceae were rarely carbapenem resistant. Multivariable analysis revealed resistance risk factors in allo-HSCT patients: fluoroquinolone resistance: adult, prolonged neutropenia, breakthrough on fluoroquinolones; noncarbapenem resistance: hospital-acquired infection, breakthrough on noncarbapenems or other antibiotics (excluding fluoroquinolones, noncarbapenems, carbapenems), donor type; carbapenem resistance: breakthrough on carbapenem, longer hospitalization, intensive care unit, previous other antibiotic therapy; multidrug resistance: longer hospitalization, breakthrough on β-lactam/β-lactamase inhibitors, and carbapenems. Inappropriate empiric therapy and mortality were significantly more common in infections caused by resistant bacteria.

Conclusions:

Our data question the recommendation for fluoroquinolone prophylaxis and call for reassessment of local empiric antibiotic protocols. Knowledge of pathogen-specific resistance enables early appropriate empiric therapy. Monitoring of resistance is crucial.

Clinical Trials Registration:

NCT02257931.

KEYWORDS:

antimicrobial resistance; bacteremia; gram-negative rods; hematopoietic stem cell transplantation

PMID:
29020364
DOI:
10.1093/cid/cix646
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for ORBi (University of Liege)
Loading ...
Support Center