Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients

results of a prospective study by the Rete Ematologica Lombarda (Rel)

Chiara Cattaneo, Patrizia Zappasodi, Valentina Mancini, Claudio Annaloro, Francesca Pavesi, Cristina Skert, A. Ferrario, Elisabetta Todisco, V. Saccà, L. Verga, A. Passi, Matteo C. Da Vià, Samantha Ferrari, G. Mometto, M. Petullà, Annamaria Nosari, Giuseppe Rossi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1955-1963
Number of pages9
JournalAnnals of Hematology
Volume95
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

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Leukemia
Prospective Studies
Bacteria
Infection
Carbapenems
Enterobacteriaceae
Pseudomonas aeruginosa
Anti-Bacterial Agents
Fluoroquinolones
Gram-Positive Bacteria
Hematology
Bacterial Infections
Epidemiology
Fungi
Fever
Lung
Mortality

Keywords

  • Acute leukaemia
  • Bloodstream infections
  • Fluoroquinolone prophylaxis
  • Multiresistant bacteria

ASJC Scopus subject areas

  • Hematology

Cite this

Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients : results of a prospective study by the Rete Ematologica Lombarda (Rel). / Cattaneo, Chiara; Zappasodi, Patrizia; Mancini, Valentina; Annaloro, Claudio; Pavesi, Francesca; Skert, Cristina; Ferrario, A.; Todisco, Elisabetta; Saccà, V.; Verga, L.; Passi, A.; Da Vià, Matteo C.; Ferrari, Samantha; Mometto, G.; Petullà, M.; Nosari, Annamaria; Rossi, Giuseppe.

In: Annals of Hematology, Vol. 95, No. 12, 01.12.2016, p. 1955-1963.

Research output: Contribution to journalArticle

Cattaneo, C, Zappasodi, P, Mancini, V, Annaloro, C, Pavesi, F, Skert, C, Ferrario, A, Todisco, E, Saccà, V, Verga, L, Passi, A, Da Vià, MC, Ferrari, S, Mometto, G, Petullà, M, Nosari, A & Rossi, G 2016, 'Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel)', Annals of Hematology, vol. 95, no. 12, pp. 1955-1963. https://doi.org/10.1007/s00277-016-2815-7
Cattaneo, Chiara ; Zappasodi, Patrizia ; Mancini, Valentina ; Annaloro, Claudio ; Pavesi, Francesca ; Skert, Cristina ; Ferrario, A. ; Todisco, Elisabetta ; Saccà, V. ; Verga, L. ; Passi, A. ; Da Vià, Matteo C. ; Ferrari, Samantha ; Mometto, G. ; Petullà, M. ; Nosari, Annamaria ; Rossi, Giuseppe. / Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients : results of a prospective study by the Rete Ematologica Lombarda (Rel). In: Annals of Hematology. 2016 ; Vol. 95, No. 12. pp. 1955-1963.
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abstract = "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.",
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