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Multicenter Study
. 2022 Nov 28;21(1):54.
doi: 10.1186/s12941-022-00544-0.

Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study

Jara R de la Court #  1   2 , Sjoukje H S Woudt #  3 , Annelot F Schoffelen  3 , Jarom Heijmans  4 , Nick A de Jonge  4 , Tjomme van der Bruggen  5 , Marije K Bomers  6 , Merel M C Lambregts  7 , Rogier P Schade  8 , Kim C E Sigaloff  6 ; ISIS-AR study group
Collaborators, Affiliations
Multicenter Study

Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study

Jara R de la Court et al. Ann Clin Microbiol Antimicrob. .

Abstract

Objectives: Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization.

Methods: Using 11 years of data (2008-2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates).

Results: We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate.

Conclusions: This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.

Keywords: Antimicrobial resistance; Colonization.; Empirical antibiotic therapy; Febrile neutropenia; Resistance surveillance; Third-generation-cephalosporin resistance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of (groups of) microorganisms by Gram-stain (A), among Gram-negative bacteria (B), among Gram-positive bacteria C and among microorganisms with unknown or non-applicable Gram-stain D in 4142 episodes of bacteraemia among 3887 patients, 2008–2018
Fig. 2
Fig. 2
Schematic overview1 of numbers of patients with (3GC-R GNB) blood and surveillance isolates, and patients with any GNB surveillance isolate followed by any GNB blood culture within 1 year (time pair) between 2008 and 2018. In total, 321 patients with time-paired isolates were identified, represented by the grey overlay. In 139 patients with 3GC-R GNB blood isolates a time-paired surveillance isolate was available, represented with the slash up to the right. In 106/139 the 3GC-R GNB blood isolates was preceded by a 3GC-R GNB surveillance isolate, represented by the crossed lines. 1The overview is included for illustrative purposes, the proportions displayed in this diagram are only an approximation of true proportions. 3GC-R third-generation cephalosporin-resistant. GNB Gram-negative bacteria
See this image and copyright information in PMC

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