Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia

Research output: Contribution to journalArticle

Abstract

Background: Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. Aim: To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. Materials & methods: The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). Results: A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. Conclusion: in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.

Original languageEnglish
Pages (from-to)357-364
Number of pages8
JournalFuture Microbiology
Volume10
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

Fingerprint

meropenem
Febrile Neutropenia
Amikacin
Bacteremia
Lactams
Ceftazidime
Anti-Bacterial Agents
Neoplasms
Drug Combinations
Therapeutics
Microbial Drug Resistance
Italy
Guidelines
Infection
Pharmaceutical Preparations
tazobactam drug combination piperacillin

Keywords

  • Amikacin
  • Bacteremia
  • Ceftazidime
  • Empirical therapy
  • Febrile neutropenia
  • Gram-negative
  • Meropenem
  • Piperacillin-tazobactam
  • Resistance

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)
  • Medicine(all)

Cite this

@article{669ab0972fb34a15aefae669fe10655a,
title = "Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia",
abstract = "Background: Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. Aim: To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. Materials & methods: The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto {"}Giannina Gaslini{"}, Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). Results: A total of 263 strains were evaluated: 27{\%} were resistant to piperacillin-tazobactam, 23{\%} to ceftazidime, 12{\%} to meropenem and 13{\%} to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6{\%} of strains for piperacillin-tazobactam, 5{\%} for ceftazidime and 5{\%} for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. Conclusion: in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.",
keywords = "Amikacin, Bacteremia, Ceftazidime, Empirical therapy, Febrile neutropenia, Gram-negative, Meropenem, Piperacillin-tazobactam, Resistance",
author = "Elio Castagnola and Ilaria Caviglia and Luisa Pescetto and Francesca Bagnasco and Riccardo Haupt and Roberto Bandettini",
year = "2015",
month = "3",
day = "1",
doi = "10.2217/FMB.14.144",
language = "English",
volume = "10",
pages = "357--364",
journal = "Future Microbiology",
issn = "1746-0913",
publisher = "Future Medicine Ltd.",
number = "3",

}

TY - JOUR

T1 - Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia

AU - Castagnola, Elio

AU - Caviglia, Ilaria

AU - Pescetto, Luisa

AU - Bagnasco, Francesca

AU - Haupt, Riccardo

AU - Bandettini, Roberto

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background: Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. Aim: To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. Materials & methods: The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). Results: A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. Conclusion: in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.

AB - Background: Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. Aim: To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. Materials & methods: The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). Results: A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. Conclusion: in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.

KW - Amikacin

KW - Bacteremia

KW - Ceftazidime

KW - Empirical therapy

KW - Febrile neutropenia

KW - Gram-negative

KW - Meropenem

KW - Piperacillin-tazobactam

KW - Resistance

UR - http://www.scopus.com/inward/record.url?scp=84926184340&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926184340&partnerID=8YFLogxK

U2 - 10.2217/FMB.14.144

DO - 10.2217/FMB.14.144

M3 - Article

C2 - 25812459

AN - SCOPUS:84926184340

VL - 10

SP - 357

EP - 364

JO - Future Microbiology

JF - Future Microbiology

SN - 1746-0913

IS - 3

ER -