How to manage infections caused by antibiotic resistant gram-negative bacteria -EBMT educational meeting from the severe aplastic anaemia and infectious diseases working parties, Naples, Italy, 2014

Research output: Contribution to journalArticle

Abstract

Multidrug resistant (MDR) Gram-negative bacteria are increasingly frequent in hematopoietic stem cell transplant (HSCT) recipients, yet their prevalence is highly variable among transplant centres. Thus, the knowledge of local epidemiology is mandatory for deciding the most appropriate management protocols. Empirical therapy of febrile neutropenia should be individualized. Either escalation or de-escalation strategy could be chosen, based on local epidemiology, individual risk factors for infection due to resistant strains, such as previous infection or colonization with a resistant pathogen, and clinical presentation. De-escalation approach is recommended in case of severe clinical presentation in patients who are at high risk of drug-resistant infection. Targeted therapy of MDR Gram-negatives, in particular carbapenem-resistant strains, calls for a combination treatment, usually including colistin. No large randomized trials exist in this setting. Local epidemiology dictates which resistant bacteria should be routinely screened for, and infection control precautions are mandatory to limit the spread of resistant strains. Antimicrobial stewardship, with the aim of the best possible management of bacterial infections, should be put in place in every transplant centre. In conclusion, infections caused by resistant Gram-negative bacteria in HSCT population warrant currently particular attention in order to limit their negative impact on transplant outcomes.

Original languageEnglish
JournalCurrent Drug Targets
Volume16
Publication statusPublished - 2015

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Keywords

  • Bloodstream infections
  • Colistin
  • De-escalation
  • Enterobacteriaceae
  • KPC-klebsiella pneumoniae
  • Multidrug resistant (MDR)
  • Pseudomonas aeruginosa
  • Transplant

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology
  • Drug Discovery
  • Clinical Biochemistry

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