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. 2015 Feb 12:5:11.
doi: 10.3389/fcimb.2015.00011. eCollection 2015.

Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis

Rima Moghnieh  1 , Nour Estaitieh  1 , Anas Mugharbil  2 , Tamima Jisr  3 , Dania I Abdallah  4 , Fouad Ziade  5 , Loubna Sinno  6 , Ahmad Ibrahim  2
Affiliations

Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis

Rima Moghnieh et al. Front Cell Infect Microbiol. .

Abstract

Introduction: Bacteremia remains a major cause of life-threatening complications in patients receiving anticancer chemotherapy. The spectrum and susceptibility profiles of causative microorganisms differ with time and place. Data from Lebanon are scarce. We aim at evaluating the epidemiology of bacteremia in cancer patients in a university hospital in Lebanon, emphasizing antibiotic resistance and risk factors of multi-drug resistant organism (MDRO)-associated bacteremia.

Materials and methods: This is a retrospective study of 75 episodes of bacteremia occurring in febrile neutropenic patients admitted to the hematology-oncology unit at Makassed General Hospital, Lebanon, from October 2009-January 2012. It corresponds to epidemiological data on bacteremia episodes in febrile neutropenic cancer patients including antimicrobial resistance and identification of risk factors associated with third generation cephalosporin resistance (3GCR) and MDRO-associated bacteremia.

Results: Out of 75 bacteremias, 42.7% were gram-positive (GP), and 57.3% were gram-negative (GN). GP bacteremias were mostly due to methicillin-resistant coagulase negative staphylococci (28% of total bacteremias and 66% of GP bacteremias). Among the GN bacteremias, Escherichia coli (22.7% of total, 39.5% of GN organisms) and Klebsiella pneumoniae(13.3% of total, 23.3% of GN organisms) were the most important causative agents. GN bacteremia due to 3GC sensitive (3GCS) bacteria represented 28% of total bacteremias, while 29% were due to 3GCR bacteria and 9% were due to carbapenem-resistant organisms. There was a significant correlation between bacteremia with MDRO and subsequent intubation, sepsis and mortality. Among potential risk factors, only broad spectrum antibiotic intake >4 days before bacteremia was found to be statistically significant for acquisition of 3GCR bacteria. Using carbapenems or piperacillin/tazobactam>4 days before bacteremia was significantly associated with the emergence of MDRO (p < 0.05).

Conclusion: Our findings have major implications for the management of febrile neutropenia, especially in breakthrough bacteremia and fever when patients are already on broadspectrum antibiotics. Emergence of resistance to 3GCs and, to a lesser extent, to carbapenems in GN isolates has to be considered seriously in our local guidelines for empiric treatment of febrile neutropenia, especially given that their occurrence was proven to be associated with poorer outcomes.

Keywords: 3GCR gram-negative bacteria; Lebanon; MDR gram-negative bacteria; bacteremia; febrile neutropenia.

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References

    1. Averbuch D., Orasch C., Cordonnier C., Livermore D. M., Mikulska M., Viscoli C., et al. (2013). ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 98, 1826–1835 10.3324/haematol.2013.091025 - DOI - PMC - PubMed
    1. Caselli D., Cesaro S., Ziino O., Zanazzo G., Manicone R., Livadiotti S., et al. . (2010). Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica 95, 1612–1615. 10.3324/haematol.2009.020867 - DOI - PMC - PubMed
    1. Clinical and Laboratory Standards Institute (CLSI) (2010). Performance Standards for Antimicrobial Susceptibility Testing: 20th Informational Supplement. Wayne, PA: CLSI.
    1. Dettenkofer M., Ebner W., Bertz H., Babikir R., Finke J., Frank U., et al. . (2003). Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant. 31, 795–801. 10.1038/sj.bmt.1703920 - DOI - PubMed
    1. Freifeld A. G., Bow E. J., Sepkowitz K. A., Boeckh M. J., Ito J. I., Mullen C. A., et al. (2011). Infectious diseases society of america clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin. Infect. Dis. 52, 427–431 10.1093/cid/ciq147 - DOI - PubMed

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