Resistance to empirical ß-lactams recommended in febrile neutropenia guidelines in Gram-negative bacilli bloodstream infections in Spain: a multicentre study.
Por:
Chumbita M, Puerta-Alcalde P, Yáñez L, Cuesta MA, Chinea A, Español Morales I, Fernández Abellán P, Gudiol C, Guerreiro M, González-Sierra P, Rojas R, María Sánchez Pina J, Sánchez Vadillo I, Varela R, Vázquez L, Lopera C, Monzó P and Garcia-Vidal C
Publicada:
29 jun 2022
Ahead of Print:
25 abr 2022
Resumen:
OBJECTIVES: To describe current resistance to the ß-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB). METHODS: Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated. RESULTS: Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three ß-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT. CONCLUSIONS: Current resistance to empirical ß-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.
Filiaciones:
Chumbita M:
Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
Puerta-Alcalde P:
Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
Yáñez L:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Cuesta MA:
Hospital Universitario Virgen de la Victoria, Málaga, Spain
Chinea A:
Hospital Universitario Ramón y Cajal, Madrid, Spain
Español Morales I:
Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
:
Hospital General Universitario de Alicante, Alicante, Spain
Gudiol C:
Hospital Universitario de Bellvitge, Institut Català d'Oncologia, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas (CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
Guerreiro M:
Hospital Universitario y Politécnico La Fe, Valencia, Spain
González-Sierra P:
Hospital Universitario Virgen de las Nieves, Granada, Spain
Rojas R:
Hospital Universitario Reina Sofía, Córdoba, Spain
María Sánchez Pina J:
Hospital Universitario 12 de Octubre, Madrid, Spain
Sánchez Vadillo I:
Hospital Universitario La Paz, Madrid, Spain
Varela R:
Hospital Universitario de A Coruña, Coruña, Spain
Vázquez L:
Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
Lopera C:
Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
Monzó P:
Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
Garcia-Vidal C:
Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
Open Access
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