1
|
Cano S, Clari MÁ, Colomina J, García L, Piqueras CS, Torres I, Aguilar G, Carbonell N, Navarro D. Off-label use of the BIOFIRE® Blood Culture Identification 2 Panel for multidrug-resistant bacteria colonization surveillance in critical care unit patients: A retrospective study. Diagn Microbiol Infect Dis 2025; 113:116930. [PMID: 40449156 DOI: 10.1016/j.diagmicrobio.2025.116930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 05/15/2025] [Accepted: 05/26/2025] [Indexed: 06/03/2025]
Abstract
In this retrospective, single-center, observational study we assessed the performance of the BIOFIRE® Blood Culture Identification 2 (BCID2) Panel for the identification of multidrug-resistant bacteria (MDRB)-colonized critical care unit patients compared with a standard culture and antimicrobial susceptibility testing (AST)-based approach. A total of 146 rectal/pharyngeal/nasal combined specimens from 130 patients were tested by using the BCID2 panel. MDRB were detected in 40/146 (27.3%) specimens from 39 patients (30%) by the BCID2 panel; MDRB were recovered by culture in 32/146 (21.9%) specimens from 30 patients (23%). Concordance between the MDRB detected by the BCID2 panel and those recovered by culture was observed in 29/43 cases; MDRB were more frequently extended-spectrum beta-lactamase-harboring Enterobacterales or vanA/B-carrying Enterococcus faecium. The per specimen positive and negative percentage agreement values were 90.6% and 90.3%, respectively (Kappa value: 0.73). The BCID2 panel shows promise as a tool for the rapid identification of MDRB carriers in critical care units. Its use may lead to prescription of more refined empirical antimicrobial therapies on an individual basis and allow timely isolation of patients to prevent MDRB spreading. Nevertheless, larger, multicenter, prospective, and Next-generation sequencing-validated studies are needed to corroborate our findings.
Collapse
Affiliation(s)
- Sofía Cano
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - María Ángeles Clari
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Colomina
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Laura García
- Critical Care Unit, Anesthesiology and Critical Care Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Cristina Sanchís- Piqueras
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Ignacio Torres
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Gerardo Aguilar
- Critical Care Unit, Anesthesiology and Critical Care Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.; Department of Surgery. University of Valencia, Valencia, Spain
| | - Nieves Carbonell
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.; Department of Microbiology School of Medicine, University of Valencia, Valencia, Spain.; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
2
|
Schwartz ER, Klein K, Lissenberg-Witte BI, Wolfs TFW, de Haas V, Goemans B, Dors N, van den Heuvel-Eibrink MM, Knops RRG, Tissing WJE, Versluys BA, Zwaan CM, van Litsenburg RRL, Kaspers GJL. Infectious Morbidity During Pediatric Acute Myeloid Leukemia Chemotherapy in a High-Income Country: A 15-Year Population-Based Overview. Pediatr Blood Cancer 2025:e31819. [PMID: 40420403 DOI: 10.1002/pbc.31819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 04/24/2025] [Accepted: 05/07/2025] [Indexed: 05/28/2025]
Abstract
INTRODUCTION Infection causes significant morbidity and mortality in pediatric acute myeloid leukemia (pAML). This study describes the incidence and risk factors of bloodstream infection (BSI) and invasive fungal infection (IFI) in pAML. METHODS A retrospective chart review was performed of patients treated according to the ANLL-97/AML-12 (N = 116), AML-15 (N = 60), or DB AML-01 (N = 67) protocols between 1998 and 2014. Cumulative incidence was analyzed for infectious outcomes (any BSI, viridans group streptococci [VGS-BSI], Gram-negative rod [GNR-BSI], IFI). Risk factors were analyzed in multivariable models. Recurrent event analyses were performed to evaluate whether previous infection(s) were related to subsequent infection. RESULTS The cumulative incidence of any BSI was 78%, VGS-BSI 35%, GNR-BSI 15%, and IFI 11% through Day 150. Incidence of GNR-BSI decreased over time; AML-15 hazard ratio ([HR] 0.37, 95% confidence interval [CI]: 0.14-0.98, p = 0.045) and DB AML-01 (HR 0.42, 95% CI: 0.18-0.97, p = 0.042) compared to ANLL-97/AML-12. White blood cell counts ≥20 × 109/L at diagnosis and older age were associated with lower infection risk. Recurrent event analyses showed a higher risk of subsequent BSI for patients who had two or more prior BSIs. CONCLUSION Despite efforts to improve supportive care in pAML, only GNR-BSI cumulative incidence declined over time. Future studies should continue working toward decreasing the incidence of infection while maintaining treatment efficacy.
Collapse
Affiliation(s)
- Emily R Schwartz
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Kim Klein
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tom F W Wolfs
- University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Valérie de Haas
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Bianca Goemans
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Natasja Dors
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rutger R G Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Groningen, Groningen, The Netherlands
| | | | - C Michel Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Raphaële R L van Litsenburg
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
3
|
Schinas G, Koros R, Ntalakouras I, Sideris S, Perperis A, Leventopoulos G, Davlouros P, Akinosoglou K. Gram-Negative Bacterial Infections in Cardiac Implantable Electronic Devices: Insights from a Retrospective Analysis of Multidrug-Resistant and Non-Multidrug-Resistant Isolates. Pathogens 2025; 14:215. [PMID: 40137700 PMCID: PMC11944461 DOI: 10.3390/pathogens14030215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 02/17/2025] [Accepted: 02/19/2025] [Indexed: 03/29/2025] Open
Abstract
Cardiac implantable electronic device (CIED) infections caused by Gram-negative bacteria are uncommon but potentially life-threatening. This study examined patients with Gram-negative CIED infections, investigating the clinical characteristics of patients harboring multidrug-resistant (MDR), versus non-MDR, isolates. A retrospective observational analysis was conducted at two tertiary Greek University Hospitals from 2015 to 2020. Patients were identified through microbiological cultures from device-related sites (pocket, lead, generator), with infections classified as MDR or non-MDR based on antimicrobial susceptibility profiles. Comprehensive data were collected, including demographic characteristics, clinical parameters, procedural details-on both the last device procedure and subsequent extraction procedure-infection-related findings, and microbiological profiles. In total, 18 patients were identified, with an equal distribution of 9 MDR and 9 non-MDR cases. The study population had a median age of 78 years, with 33.3% female patients, and a median Charlson Comorbidity Index of four. Pseudomonas aeruginosa was the most prevalent isolated species. Comparative analysis revealed that MDR patients had higher median SOFA (Sequential Organ Failure Assessment) scores (2 vs. 0, p = 0.07), longer time to device extraction (50% vs. 88.9% extracted within one month, p = 0.079), and higher blood culture positivity (80% vs. 37.5%, p = 0.135). Despite similar demographic characteristics, MDR infections demonstrated more complex clinical profiles, with a trend towards increased disease severity.
Collapse
Affiliation(s)
- Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.L.); (P.D.)
| | - Rafail Koros
- Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece; (R.K.); (A.P.)
| | - Ioannis Ntalakouras
- Department of Cardiology, Ippokrateio General Hospital of Athens, 11527 Athens, Greece; (I.N.); (S.S.)
| | - Skevos Sideris
- Department of Cardiology, Ippokrateio General Hospital of Athens, 11527 Athens, Greece; (I.N.); (S.S.)
| | - Angelos Perperis
- Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece; (R.K.); (A.P.)
| | - Georgios Leventopoulos
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.L.); (P.D.)
- Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece; (R.K.); (A.P.)
| | - Periklis Davlouros
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.L.); (P.D.)
- Division of Cardiology, University General Hospital of Patras, 26504 Rio, Greece; (R.K.); (A.P.)
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.L.); (P.D.)
- Department of Internal Medicine and Division of Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
| |
Collapse
|
4
|
Wang H, Li S, Ji H, Hu Y, Zhou S, Chen X, Lu Z, You Q, Cheng Y, Zha L. Epidemiology and Antimicrobial Resistance of Stenotrophomonas maltophilia in China, 2014-2021. Infect Dis Ther 2025; 14:261-274. [PMID: 39731666 PMCID: PMC11782787 DOI: 10.1007/s40121-024-01099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 12/11/2024] [Indexed: 12/30/2024] Open
Abstract
INTRODUCTION Stenotrophomonas maltophilia is an opportunistic pathogen associated with various nosocomial infections and is known for its intrinsic multidrug resistance. This study aims to provide a comprehensive overview of the epidemiology and resistance patterns of S. maltophilia in China from 2014 to 2021. METHODS Data were extracted from the China Antimicrobial Resistance Surveillance System (CARSS) and the Blood Bacterial Resistance Investigation Collaborative System (BRICS), encompassing 1412 medical institutions across 31 provinces in China. We analyzed the prevalence of S. maltophilia in clinical isolates, focusing on specific patient populations and departments, as well as resistance profiles to recommended first-line antibiotics, including sulfamethoxazole-trimethoprim, levofloxacin, and minocycline. RESULTS A total of 514,768 S. maltophilia strains were analyzed. The overall prevalence of S. maltophilia among all clinical bacterial isolates remained stable at approximately 2.1%, with higher rates observed in intensive care units and elderly patients. Resistance rates to sulfamethoxazole-trimethoprim decreased from 9.8% in 2014 to 7.5% in 2021. In contrast, resistance to levofloxacin showed a slight upward trend, increasing from 8.5% in 2014 to 9.5% in 2021. Meanwhile, minocycline resistance remained low, fluctuating marginally from 2.7% in 2014 to 1.7% in 2021. CONCLUSIONS This study highlights the stable prevalence of S. maltophilia in clinical settings in China and the overall low resistance rates to recommended first-line antibiotics. However, alarmingly high resistance rates were observed in specific specimen types, particularly in blood cultures, suggesting that minocycline may be the only reliable therapeutic option among the six tested antibiotics for treating such infections in China. Continuous surveillance and effective infection control measures are essential to manage S. maltophilia infections, particularly in vulnerable populations. Future research should focus on measuring the true burden of these infections and monitoring the susceptibility of the newly introduced antibiotics, such as cefiderocol.
Collapse
Affiliation(s)
- Hanli Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China
| | - Shirong Li
- Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, No. 259 Jiuhua Middle Road, Wuhu, 241000, Anhui, China
| | - Haoyu Ji
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China
| | - Yixin Hu
- Xi'an Jiaotong-Liverpool University, No. 111 Ren'ai Road, SuZhou, 215000, Jiangsu, China
| | - Susheng Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China
| | - Xingwu Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China
| | - Zhiwei Lu
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China
| | - Qinghai You
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China
| | - Yusheng Cheng
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China.
| | - Lei Zha
- Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College, No 2 Zheshan West Road, Wuhu, 241000, Anhui, China.
| |
Collapse
|
5
|
Vasileiadi E, Lloyd KM, Fisher BT, Hanisch B. Fluoroquinolone Prophylaxis in Children With Cancer: A Pro/Con Discussion. J Pediatric Infect Dis Soc 2024; 13:486-492. [PMID: 39073450 DOI: 10.1093/jpids/piae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/26/2024] [Indexed: 07/30/2024]
Abstract
There are conflicting recommendations on whether to use or not to use fluoroquinolone prophylaxis in pediatric oncology patients. An international pediatric clinical practice guideline (CPG) recommends administering levofloxacin prophylaxis in patients with acute myeloblastic leukemia and relapsed acute lymphoblastic leukemia receiving intensive chemotherapy as this practice has been found to reduce episodes of fever and bacteremia. A separate European CPG does not recommend levofloxacin prophylaxis because of concerns for adverse effects, including potentiation of fluoroquinolone resistance and possible increased resistance to other classes of antibiotics. The nuance of the decision to give or not give prophylaxis is discussed in the context of published evidence defining the risks and benefits of levofloxacin prophylaxis for pediatric leukemia patients at high risk for bacterial infection. Knowledge gaps are also identified to guide further investigations to optimize the use of fluoroquinolone prophylaxis in pediatric patients receiving chemotherapy for cancer or undergoing a hematopoietic cell transplantation.
Collapse
Affiliation(s)
- Eleana Vasileiadi
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kevin M Lloyd
- Department of Pediatric Infectious Diseases, Children's National, Washington, District of Columbia, USA
| | - Brian T Fisher
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin Hanisch
- Department of Pediatric Infectious Diseases, Children's National, Washington, District of Columbia, USA
| |
Collapse
|
6
|
Carbonell N, Oltra MR, Clari MÁ. Stenotrophomonas maltophilia: The Landscape in Critically Ill Patients and Optimising Management Approaches. Antibiotics (Basel) 2024; 13:577. [PMID: 39061259 PMCID: PMC11273807 DOI: 10.3390/antibiotics13070577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this review is to synthesise the key aspects of the epidemiology, current microbiological diagnostic challenges, antibiotic resistance rates, optimal antimicrobial management, and most effective prevention strategies for Stenotrophomonas maltophilia (SM) in the intensive care unit (ICU) population. In recent years, resistance surveillance data indicate that SM accounts for less than 3% of all healthcare-associated infection strains, a percentage that doubles in the case of ventilator-associated pneumonia (VAP). Interestingly, SM ranks as the third most isolated non-glucose fermenter Gram-negative bacilli (NFGNB). Although this NFGNB genus has usually been considered a bystander and colonising strain, recently published data warn about its potential role as a causative pathogen of severe infections, particularly pneumonia and bloodstream infections (BSI), not only for the classical immunocompromised susceptible host patients but also for critically ill ones even without overt immunosuppression. Indeed, it has been associated with crude 28-day mortality as high as 54.8%, despite initial response following targeted therapy. Additionally, alongside its intrinsic resistance to a wide range of common antimicrobials, various worldwide and local surveillance studies raise concerns about an increase in ICU settings regarding resistance to first-line drugs such as cotrimoxazole or tigecycline. This scenario alerts ICU physicians to the need to reconsider the best stewardship approach when SM is isolated in obtained samples from critically ill patients. Despite the coverage of this multidrug-resistant bacterium (MDRB) provided by some traditional and a non-negligible number of current pipeline antimicrobials, an ecological and cost-effective strategy is needed in the present era.
Collapse
Affiliation(s)
- Nieves Carbonell
- Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain
| | - María Rosa Oltra
- Infectious Disease Unit, Internal Medicine Department, Clinic University Hospital, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| | - María Ángeles Clari
- Microbiology Service, Clinic University Hospital, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain;
| |
Collapse
|
7
|
Kamel NA, Abdalla MS, Al Ali A, Alshahrani MY, Aboshanab KM, El Borhamy MI. Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation. Infect Drug Resist 2024; 17:2249-2260. [PMID: 38854781 PMCID: PMC11162205 DOI: 10.2147/idr.s463868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Owing to the rising incidence of multidrug-resistant organisms (MDRO) and the high mortality rates associated with such bacterial infections post-hematopoietic stem cell transplantation (HSCT), we investigated the MDRO colonization rate prior to transplantation using an active surveillance approach and determined its impact on subsequent infection during the pre-engraftment period. Methods A single-center observational study was conducted, and surveillance cultures from multiple body sites, including the rectum, nasal cavity, and groin, were performed at admission to determine MDRO colonization. Serological tests were used to detect certain viruses and toxoplasmosis before HSCT. Results In the pre-transplant setting, 59 MDRO were recovered from the 40 HSCT recipients. Of the 59 isolates recovered from one or more body sites, 29 were positive for methicillin-resistant Staphylococcus aureus (MRSA), 7 for carbapenem-resistant Enterobacterales (CRE), and 23 were positive for extended-spectrum β-lactamase (ESBLs). Serological assessment before HSCT revealed active or reactivation of latent infection with cytomegalovirus (7.5%), Epstein-Barr virus (EBV; 5%), and Toxoplasma gondii (2.5%) among HSCT patients. In terms of factors associated with pre-engraftment infections, the type of transplant (p=0.04) was statistically significant, whereas other factors, such as age, sex, and underlying conditions, were not. In post-transplant settings, bloodstream infections (BSIs) were documented in 2 allogeneic HSCT patients (5%), and the isolated microorganisms were ESBL-producing E. coli and non-MDR Acinetobacter baumannii. Conclusion Active screening cultures are a helpful tool for identifying patients colonized by MDRO or relevant viruses before HSCT, and for predicting those at risk of developing subsequent pre-engraftment infections. Additionally, active screening may aid in predicting those who are likely to develop subsequent pre-engraftment infections Our findings highlight the importance of pre-transplant screening for high-priority multidrug-resistant pathogens and the application of infection control interventions after HSCT.
Collapse
Affiliation(s)
- Noha A Kamel
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Mahmoud S Abdalla
- Hematology and Bone Marrow Transportation (BMT) Unit, International Medical Center (IMC), Cairo, Egypt
| | - Amer Al Ali
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia
| | - Mohammad Y Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 9088, Saudi Arabia
| | - Khaled M Aboshanab
- Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, University Technology MARA (Uitm), Campus Puncak Alam, Bandar Puncak Alam, Selangor, 42300, Malaysia
| | - Mervat I El Borhamy
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
- International Medical Center, Clinical Microbiology Laboratory, Cairo, Egypt
| |
Collapse
|
8
|
Delanote V, Callens R, Vogelaers D, Deeren D. Screening for multidrug-resistant organisms in high-risk hospitalized patients with hematologic diseases. Eur J Haematol 2024; 112:627-632. [PMID: 38122813 DOI: 10.1111/ejh.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Patients treated for hematologic malignancies are at higher risk for blood stream infections (BSI) and multidrug-resistant organisms (MDRO) are increasingly involved. Studies showed a significant association between rectal colonization status and a higher risk of subsequent MDRO BSI. The objective of our study was to probe the practice of surveillance cultures in Belgian hematology centers. METHODS A questionnaire was sent to the 13 hematology centers participating in the acute leukemia board of the Belgian Hematology Society. 21 questions probed for the method of surveillance cultures, MDRO screened, antimicrobial prophylaxis, and empirical therapy and their relationship with colonization status. RESULTS All centers completed the questionnaire in full. Routine gastrointestinal surveillance cultures in hematologic patients are taken in 10 hospitals. Organisms tested for included mostly ESBL (n = 9) and carbapenem-resistant (n = 8) Enterobacterales. All centers with a screening strategy adapt empiric antibiotic therapy based on MDRO colonization. Prophylaxis strategies are variable, only two centers adapt prophylaxis upon documentation of fluoroquinolone resistance. CONCLUSIONS The majority of the Belgian centers perform routine surveillance cultures and adapt empiric therapy for neutropenic fever accordingly. Other reasons for testing include to gain insight into local epidemiology and to prevent in-hospital transmission. In general, there was significant variability in surveillance dimensions.
Collapse
Affiliation(s)
- Valentine Delanote
- AZ Delta internal medicine, AZ Delta General Hospital, Roeselare, Belgium
| | - Rutger Callens
- AZ Delta Clinical Hematology, AZ Delta General Hospital, Roeselare, Belgium
| | - Dirk Vogelaers
- AZ Delta Infectiology, AZ Delta General Hospital, Roeselare, Belgium
- Faculty of Health sciences, University Ghent, Ghent, Belgium
| | - Dries Deeren
- AZ Delta Clinical Hematology, AZ Delta General Hospital, Roeselare, Belgium
| |
Collapse
|
9
|
Zeng B, Liu P, Wu X, Zheng F, Jiang J, Zhang Y, Liao X. Comparison of ANN and LR models for predicting Carbapenem-resistant Klebsiella pneumoniae isolates from a southern province of China's RNSS data. J Glob Antimicrob Resist 2024; 36:453-459. [PMID: 37918787 DOI: 10.1016/j.jgar.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious threat to public health due to its limited treatment options and high mortality rate. This study aims to identify the risk factors of carbapenem resistance in patients with K. pneumoniae isolates and develop CRKP prediction models using logistic regression (LR) and artificial neural network (ANN) methods. METHODS We retrospectively analysed the data of 49,774 patients with Klebsiella pneumoniae isolates from a regional nosocomial infection surveillance system (RNSS) between 2018 and 2021. We performed logistic regression analyses to determine the independent predictors for CRKP. We then built and evaluated LR and ANN models based on these predictors using calibration curves, ROC curves, and decision curve analysis (DCA). We also applied the Synthetic Minority Over-Sampling Technique (SMOTE) to balance the data of CRKP and non-CRKP groups. RESULTS The LR model showed good discrimination and calibration in both training and validation sets, with areas under the ROC curve (AUROC) of 0.824 and 0.825, respectively. The DCA indicated that the LR model had clinical usefulness for decision making. The ANN model outperformed the LR model both in the training set and validation set. The SMOTE technique improved the performance of both models for CRKP detection in training set, but not in the validation set. CONCLUSION We developed and validated LR and ANN models for predicting CRKP based on RNSS data. Both models were feasible and reliable for CRKP inference and could potentially assist clinicians in selecting appropriate empirical antibiotics and reducing unnecessary medical resource utilization.
Collapse
Affiliation(s)
- Bangwei Zeng
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China.
| | - Peijun Liu
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Xiaoyan Wu
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Feng Zheng
- Information Department, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Jiehong Jiang
- Hangzhou Xinlin Information Technology Company, Hangzhou City, Zhejiang Province, China
| | - Yangmei Zhang
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Xiaohua Liao
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| |
Collapse
|
10
|
Predavec N, Perčinić A, Herljević Z, Rezo Vranješ V, Pavlović M, Šalek Z, Kuliš T, Bilić E, Mareković I. Bacteriuria in Paediatric Oncology Patients: Clinical Features, Distribution and Antimicrobial Susceptibility of Bacterial Pathogens at University Hospital Centre Zagreb, Croatia over a 4-Year Period. Antibiotics (Basel) 2024; 13:118. [PMID: 38391504 PMCID: PMC10886334 DOI: 10.3390/antibiotics13020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Bacteriuria in paediatric oncology patients have not been well studied. This retrospective study analysed clinical features, distribution and antimicrobial susceptibility of bacterial pathogens cultured from urine in paediatric oncology patients over a 4-year period (2019-2022). A total of 143 episodes of bacteriuria were documented in 74 patients. Neutropenia was present in 17.5% (25/143), symptoms in 25.9% (37/143) and urinary catheter in 7.0% (10/143) episodes. Symptomatic bacteriuria episodes were statistically significantly more frequent in patients with neutropenia (p = 0.0232). The most common bacterial pathogens were Escherichia coli (n = 49; 32.2%), Klebsiella spp. (n = 34; 22.4%), Pseudomonas aeruginosa (n = 22; 14.5%) and Enterococcus spp. (n = 21; 13.8%). Extended-spectrum β-lactamases-producing (ESBL) Enterobacterales were found in 11 episodes (11/143; 7.7%) with the highest proportion among Klebsiella pneumoniae isolates (n = 7/34; 20.6%). No carbapenem-resistant Enterobacterales, multidrug-resistant P. aeruginosa or vancomycin-resistant Enterococcus spp. were found. The most important novelties are demonstrating P. aeruginosa as one of the prominent bacteriuria pathogens in this patient population, presence of ESBL isolates and carbapenem-resistant P. aeruginosa later during hospitalization highlights the need for appropriate antimicrobial treatment. However, because of the small number of symptomatic patients, further studies are needed to clarify the importance of including urine culture in the diagnostic process in patients with febrile neutropenia.
Collapse
Affiliation(s)
- Nina Predavec
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Antonio Perčinić
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Herljević
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Violeta Rezo Vranješ
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Pavlović
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zrinko Šalek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Ernest Bilić
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Mareković
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
11
|
Katkowska M, Garbacz K, Kwapisz E, Suligowska K, Kusiak A, Cichońska D, Świetlik D. High oral carriage of multidrug resistant Gram-negative bacilli in adolescents: the SOPKARD-Junior study. Front Cell Infect Microbiol 2023; 13:1265777. [PMID: 38035342 PMCID: PMC10687414 DOI: 10.3389/fcimb.2023.1265777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The colonization of the oral cavity by potentially pathogenic antimicrobial-resistant bacteria in adolescents and its consequences is very poorly understood. The present study focused on the occurrence of oral colonization by Gram-negative bacilli (GNB) and their multidrug resistance, including the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases, among healthy adolescents and risk factors associated with GNB colonization. Materials and methods This study was conducted as part of "A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior" (SOPKARD-Junior). Oral samples were collected from 182 adolescents from four public elementary schools in Sopot, Poland, aged 13-14 years. Bacterial strains were identified by the MALDI-TOF MS method. Screening of antimicrobial resistance was performed using a disk diffusion method. The NG-Test® CARBA-5 was used to detect and differentiate the five most widely distributed carbapenemases. Demographic and clinical data were collected and statistical analysis of risk factors was performed. Results A total of 68 out of 182 (37.4%) healthy adolescents was documented oral colonization with Gram-negative bacilli, including 50/182 (27.5%) multidrug resistant (MDR-GNB) strains. Over 60% of oral carriage concerned three main genera Enterobacter spp., Pseudomonas spp., and Serratia spp., which were detected in 22.1%, 19.1%, and 19.1% of participants, respectively. Citrobacter spp., Escherichia coli, Klebsiella spp., Hafnia spp., Aeromonas spp., Acinetobacter spp., and Stenotrophomonas spp. were also isolated. The antimicrobial resistance to ampicillin (100%), ceftazidime (69.1%), meropenem (60.3%), gentamycin (60.3%), piperacillin/tazobactam (52.9%), and piperacillin (45.6%) were the most common. Among 73.5% GNB strains multidrug resistance was observed, including all Pseudomonas spp. strains. Among MDR-GNB, 30.4% were resistant to four groups of antibiotics, half of the MDR Pseudomonas spp. strains were resistant to 10 groups of antibiotics. Extended-spectrum β-lactamases were produced by Enterobacter cloacae, Klebsiella spp., and Serratia spp. (7.4%). Colonization by ESBLs-positive GNB strains was significantly associated with recurrent respiratory infections, nasal congestion, and bronchitis (p<0.05). Conclusion Our study revealed high oral carriage of multi-drug resistant Gram-negative bacilli in healthy adolescents and the association of ESBL-producing strains with respiratory infections. Further studies on oral colonization with GNB are necessary due to the possibility of distinct infections and the acquisition of antibiotic resistance by resident microbiota.
Collapse
Affiliation(s)
- Marta Katkowska
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Kwapisz
- Department of Oral Microbiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Klaudia Suligowska
- Department of Dental Techniques and Masticatory System Dysfunctions, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- Department of Preventive Medicine and Education, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Świetlik
- Division of Biostatistics and Neural Networks, Medical University of Gdansk, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
12
|
Moreno AF, Lavín-Alconero L, de Ugarriza PL, Blanco LS, Hernández SC, Burgués JMB, de Miguel MI, Huerta AJG, Zarzuela MP, Boluda B, Humala K, Calabuig ML, Amigo ML, Casas MC, Del Mar García-Saiz M, Verdugo AF, Domínguez JF, Bernal T. FOVOCIP study: a multicenter randomized trial of fosfomycin versus ciprofloxacin for febrile neutropenia in hematologic patients-efficacy and microbiologic safety. Trials 2023; 24:694. [PMID: 37891616 PMCID: PMC10612155 DOI: 10.1186/s13063-023-07702-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Multidrug-resistant Gram-negative bacterial (MRGNB) infections represent a major public health threat. Cancer patients and, among them, hematological patients are most vulnerable to these infections. Gut colonization by MRGNB is a common phenomenon occurring during hospitalization and chemotherapy exposure. In the neutropenic phase that occurs after chemotherapy, MRGNB translocation occurs increasing patient's mortality. Fluoroquinolone prophylaxis with ciprofloxacin or levofloxacin efficacy is now being questioned due to the increase of incidence in MRGNB. METHODS A phase III randomized, controlled, clinical trial, open-label parallel-group with a 1:1 ratio, aimed to demonstrate the non-inferiority of oral fosfomycin versus oral ciprofloxacin for febrile neutropenia prevention in patients with acute leukemia (AL) or hematopoietic cell transplant (HSC) receptors. Weekly surveillance cultures are planned to detect gut colonization. Changes in fecal microbiome at the beginning and end of prophylaxis will also be analyzed. DISCUSSION This trial will provide evidence of the efficacy of an alternative drug to ciprofloxacin for febrile neutropenia prevention in high-risk hematological patients. The battery of planned microbiological studies will allow us to evaluate prospectively the microbiological safety of both pharmacological strategies in terms of the selection of MRGNB occurring in each arm. In addition, valuable information on the way in which each drug changes the fecal microbiome of the patients throughout the treatment will be generated. TRIAL REGISTRATION Clinical trials NCT05311254, Registered on 5 April 2022, https://clinicaltrials.gov/ct2/show/NCT05311254?term=FOVOCIP&cntry=ES&draw=2&rank=1 . PROTOCOL VERSION 3.0, dated 20 May 2022.
Collapse
Affiliation(s)
- Ainhoa Fernández Moreno
- Hematology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain
| | - Lucía Lavín-Alconero
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Paula López de Ugarriza
- Hematology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Avenida Roma, 33011, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain
| | - Laura Solán Blanco
- Hematology Department, Fundación Jiménez Díaz, Av. Reyes Católicos, 28040, Madrid, Spain
| | - Sara Cáceres Hernández
- Hematology Department, San Pedro Alcántara Hospital, C/Pablo Naranjo Porras, 10003, Cáceres, Spain
| | | | | | | | - Marta Polo Zarzuela
- Hematology Department, University Clinic Hospital San Carlos, C/Prof. Martín Lagos, 28040, Madrid, Spain
| | - Blanca Boluda
- Hematology Department, Instituto de Investigación, University Hospital La Fe, Avinguda Fernando Abril Martorell, 46026, Valencia, Spain
| | - Karem Humala
- Hematology Department, University Hospital La Paz, Paseo de La Castellana, 28046, Madrid, Spain
| | - Maria Luisa Calabuig
- Hematology Department, University Clinic Hospital of Valencia, Av Blasco Ibañez, 46010, Valencia, Spain
| | - Maria Luz Amigo
- Hematology Department, University Hospital Morales Messeguer, C/Marqués de los Vélez, 30008, Murcia, Spain
| | - Marián Cuesta Casas
- Hematology Department, University Hospital Carlos Haya, Av Carlos Haya, 29010, Malaga, Spain
| | - María Del Mar García-Saiz
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
| | - Ana Fernández Verdugo
- Microbiology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
| | - Javier Fernández Domínguez
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain
- Microbiology Department, University Hospital Central of Asturias, Avenida Roma, 33011, Oviedo, Spain
- CIBER_Enfermedades Respiratorias ISCIII, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
| | - Teresa Bernal
- Instituto Universitario de Oncología del Principado de Asturias, C/ Fernando Bongera, 33006, Oviedo, Spain.
- Clinical Trials Agency Valdecilla-IDIVAL, Marqués de Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
- Department of Clinical Pharmacology, Marqués de, Valdecilla University Hospital, Av. Valdecilla, 25, 39008, Santander, Cantabria, Spain.
- CIBER_Enfermedades Respiratorias ISCIII, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
| |
Collapse
|
13
|
Alves J, Abreu B, Palma P, Alp E, Vieceli T, Rello J. Antimicrobial Stewardship on Patients with Neutropenia: A Narrative Review Commissioned by Microorganisms. Microorganisms 2023; 11:1127. [PMID: 37317101 DOI: 10.3390/microorganisms11051127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 06/16/2023] Open
Abstract
The emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority.
Collapse
Affiliation(s)
- Joana Alves
- Infectious Diseases Department, Hospital de Braga, 4710-243 Braga, Portugal
| | - Betânia Abreu
- Pharmaceuticals Department, Hospital de Braga, 4710-243 Braga, Portugal
| | - Pedro Palma
- Infectious Diseases Department, Centro Hospitalar do Tâmega e Sousa, 4564-007 Penafiel, Portugal
| | - Emine Alp
- Infectious Diseases and Clinical Microbiology Department, Ankara Yıldırım Beyazıt University, 06760 Ankara, Turkey
| | - Tarsila Vieceli
- Infectious Diseases Department, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
| | - Jordi Rello
- Clinical Research in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), 08035 Barcelona, Spain
- FOREVA Research Pôle, Centre Hôpitalaire Universitaire de Nîmes, 30900 Nîmes, France
| |
Collapse
|
14
|
Reynolds D, Burnham JP, Vazquez Guillamet C, McCabe M, Yuenger V, Betthauser K, Micek ST, Kollef MH. The threat of multidrug-resistant/extensively drug-resistant Gram-negative respiratory infections: another pandemic. Eur Respir Rev 2022; 31:220068. [PMID: 36261159 PMCID: PMC9724833 DOI: 10.1183/16000617.0068-2022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/09/2022] [Indexed: 12/22/2022] Open
Abstract
Antibiotic resistance is recognised as a global threat to human health by national healthcare agencies, governments and medical societies, as well as the World Health Organization. Increasing resistance to available antimicrobial agents is of concern for bacterial, fungal, viral and parasitic pathogens. One of the greatest concerns is the continuing escalation of antimicrobial resistance among Gram-negative bacteria resulting in the endemic presence of multidrug-resistant (MDR) and extremely drug-resistant (XDR) pathogens. This concern is heightened by the identification of such MDR/XDR Gram-negative bacteria in water and food sources, as colonisers of the intestine and other locations in both hospitalised patients and individuals in the community, and as agents of all types of infections. Pneumonia and other types of respiratory infections are among the most common infections caused by MDR/XDR Gram-negative bacteria and are associated with high rates of mortality. Future concerns are already heightened due to emergence of resistance to all existing antimicrobial agents developed in the past decade to treat MDR/XDR Gram-negative bacteria and a scarcity of novel agents in the developmental pipeline. This clinical scenario increases the likelihood of a future pandemic caused by MDR/XDR Gram-negative bacteria.
Collapse
Affiliation(s)
- Daniel Reynolds
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Mikaela McCabe
- Dept of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, MO, USA
| | - Valerie Yuenger
- Dept of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, MO, USA
| | - Kevin Betthauser
- Dept of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, MO, USA
| | - Scott T Micek
- Dept of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, MO, USA
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
15
|
Guidance of empirical antimicrobial therapy by surveillance cultures in high-risk neutropenic patients: a retrospective cohort study. Antimicrob Resist Infect Control 2022; 11:160. [PMID: 36529742 PMCID: PMC9759862 DOI: 10.1186/s13756-022-01198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In neutropenic patients, bloodstream infections (BSI) significantly contribute to morbidity and mortality. Appropriate empirical antibiotic therapy (EAT) of BSI is essential, at the same time overconsumption of very broad-spectrum antibiotics should be avoided. We investigated: (1) whether surveillance cultures can predict BSI with third-generation cephalosporin -resistant Enterobacterales and Pseudomonas aeruginosa (3GC-R), (2) the effect of inappropriate empirical antimicrobial therapy (IEAT) on clinical outcome and (3) the potential reduction of carbapenem use when using surveillance cultures to guide therapy. METHODS Retrospective study of adult patients with haematological malignancies with febrile episodes during chemotherapy-induced high-risk neutropenia in whom surveillance cultures were collected weekly. IEAT was defined as the absence of in vitro susceptibility of blood-isolates to the administered EAT. Clinical outcome (ICU admission and death) was evaluated within 30 days. RESULTS A total of 673 febrile episodes occurred among 372 high-risk neutropenic patients. BSI was present in 20.1% (135/673), of which 25.9% (35/135) were due to Enterobacterales and P. aeruginosa. Of these, 17/35 were 3GC-R and 70.6% (12/17) were preceded by 3GC-R colonization. Negative predictive value of surveillance cultures for 3GC-R BSI was 99.1%. IEAT due to (3GC-R) BSI was not significantly associated with clinical outcome. Using surveillance cultures to guide EAT could potentially reduce carbapenem use by 82.8%, when compared to standard EAT with carbapenem. CONCLUSIONS This retrospective analysis shows that in patients with high-risk neutropenia, surveillance cultures can potentially reduce the use of carbapenems with infrequent IEAT for 3GC-R BSI and no negative impact on clinical outcome.
Collapse
|