TY - JOUR
T1 - Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients
T2 - results of a prospective study by the Rete Ematologica Lombarda (Rel)
AU - Cattaneo, Chiara
AU - Zappasodi, Patrizia
AU - Mancini, Valentina
AU - Annaloro, Claudio
AU - Pavesi, Francesca
AU - Skert, Cristina
AU - Ferrario, A.
AU - Todisco, Elisabetta
AU - Saccà, V.
AU - Verga, L.
AU - Passi, A.
AU - Da Vià, Matteo C.
AU - Ferrari, Samantha
AU - Mometto, G.
AU - Petullà, M.
AU - Nosari, Annamaria
AU - Rossi, Giuseppe
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Multiresistant bacterial infections are a potentially life-threatening condition in acute leukaemia (AL) patients. We aimed to better define the very recent epidemiology and outcome of bloodstream infections (BSIs) in a real-life setting. We prospectively collected all consecutive febrile/infectious episodes occurring in AL patients admitted to 9 haematology units. In 293 AL patients, 433 BSIs were diagnosed. Gram-positive (GP) bacteria were isolated in 44.8 % BSI and Gram-negative (GN) in 38.3 %, while polymicrobial aetiology- or fungi-related events were identified in 15.7 and 1.1 % of the cases, respectively. GP was observed more frequently in patients not in complete remission (p = 0.04), while GN during consolidation cycles (p = 0.003). Extended spectrum β-lactamase-producing strains accounted for 23.2 % of enterobacteria. They were associated with previous antibiotic exposure, including fluoroquinolones prophylaxis (p = 0.01). Carbapenem-resistant (CR) strains occurred in 9 % of enterobacteria. Among Pseudomonas aeruginosa strains, 21.6 % were multiresistant. Overall 30-day mortality was 8.5 %. CR GN and multiresistant P. aeruginosa BSIs were independent predictors of death (p = 0.002), as well as relapsed/resistant AL (18.3 %; p = 0.0002) and the presence of pulmonary infiltrates (26.6 %; p < 0.001). Although GP still predominate over GN BSI, the percentage of antibiotic resistant GN strains is considerable in AL patients and it is associated with poor prognosis.
AB - Multiresistant bacterial infections are a potentially life-threatening condition in acute leukaemia (AL) patients. We aimed to better define the very recent epidemiology and outcome of bloodstream infections (BSIs) in a real-life setting. We prospectively collected all consecutive febrile/infectious episodes occurring in AL patients admitted to 9 haematology units. In 293 AL patients, 433 BSIs were diagnosed. Gram-positive (GP) bacteria were isolated in 44.8 % BSI and Gram-negative (GN) in 38.3 %, while polymicrobial aetiology- or fungi-related events were identified in 15.7 and 1.1 % of the cases, respectively. GP was observed more frequently in patients not in complete remission (p = 0.04), while GN during consolidation cycles (p = 0.003). Extended spectrum β-lactamase-producing strains accounted for 23.2 % of enterobacteria. They were associated with previous antibiotic exposure, including fluoroquinolones prophylaxis (p = 0.01). Carbapenem-resistant (CR) strains occurred in 9 % of enterobacteria. Among Pseudomonas aeruginosa strains, 21.6 % were multiresistant. Overall 30-day mortality was 8.5 %. CR GN and multiresistant P. aeruginosa BSIs were independent predictors of death (p = 0.002), as well as relapsed/resistant AL (18.3 %; p = 0.0002) and the presence of pulmonary infiltrates (26.6 %; p < 0.001). Although GP still predominate over GN BSI, the percentage of antibiotic resistant GN strains is considerable in AL patients and it is associated with poor prognosis.
KW - Acute leukaemia
KW - Bloodstream infections
KW - Fluoroquinolone prophylaxis
KW - Multiresistant bacteria
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U2 - 10.1007/s00277-016-2815-7
DO - 10.1007/s00277-016-2815-7
M3 - Article
VL - 95
SP - 1955
EP - 1963
JO - Revue d'hématologie
JF - Revue d'hématologie
SN - 0939-5555
IS - 12
ER -