Elsevier

Journal of Infection

Volume 68, Issue 4, April 2014, Pages 321-331
Journal of Infection

Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients

https://doi.org/10.1016/j.jinf.2013.12.006Get rights and content

Summary

Objectives

A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients.

Methods

A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres.

Results

For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15–24%), aminoglycoside-resistant Gram-negatives (5–14%) and carbapenem-resistant P. aeruginosa (5–14%) were substantial, and significantly higher in South-East vs. North-West Europe.

Conclusions

The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy.

Introduction

Appropriate empirical antibiotic therapy is critical to outcome in cases of fever among severely immunocompromised patients, such as those who are neutropenic, have haematological malignancies, or receive hematopoietic stem cell transplants (HSCT). Empirical treatment regimens typically include a beta-lactam, with or without an aminoglycoside, and they should be active against Gram-negative bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa.1 To provide the best empirical coverage, it is critical to have a good knowledge of general and local trends in infection aetiology and resistance patterns.

During the 1980s and early 1990s, the proportion of infections due to Gram-positive pathogens in neutropenic patients rose2, 3; subsequently this trend has been reversing in some centres, with Gram-negative pathogens again becoming relatively more prevalent.4, 5, 6 In haematology wards, as elsewhere, there is a significant increase in the proportion of infections caused by multidrug-resistant (MDR) bacteria, especially Gram-negative rods with extended-spectrum spectrum beta-lactamases (ESBLs). Some centres report increases in vancomycin-resistant enterococci (VRE).7, 8, 9

The present analysis sought to establish whether these shifts were widespread and explored the potential implications for empirical antibiotic regimens employed to manage fever arising during neutropenia.

Section snippets

Materials and methods

The study included a review of recently-published relevant literature data and a questionnaire sent to various hospitals, seeking information on their current aetiology and resistance patterns of bacteraemia in haematology and oncology patients.

Literature search

Overall, 847 articles were retrieved, 322 abstracts screened, and 95 manuscripts selected for further evaluation. Among these, 49 provided relevant data: 16 both on epidemiology and resistance, 29 only on epidemiology and 4 only on resistance. Data from 3 manuscripts including both adults and children were analysed together with other data for adults, whereas data on children only were analysed separately. Twelve (60%) of 20 papers reporting susceptibility data used CLSI interpretative criteria

Discussion

Surprisingly few up-to-date analyses of the aetiology and resistance patterns of bacteraemia pathogens are available for haematology/oncology patients. Although several single-centre retrospective analyses have been published in the last 10 years, many refer to isolates obtained earlier. Since then, the aetiology of bacteraemias in these centres may have changed, reflecting different management protocols. More importantly, changes in resistance patterns almost certainly have occurred with

Funding

The ECIL-4 meeting has been supported by unrestricted educational grants from Astellas Pharma, Gilead Sciences, Merck and Pfizer.

Conflict of interest

DML has shareholdings Dechra, Merck and Pfizer and has accepted grants, speaking invitations and conference invitations from Achaogen, Merck, Pfizer, Novartis, AstraZeneca and Astellas; he has advisory or consultancy relationships with Achaogen, Adenium, Allecra, BioVersys, AstraZeneca, Basilea, Bayer, Cubist, Curetis, Discuva, GlaxoSmithKline, Kalidex, McKinsey, Meiji, Pfizer, Roche, Tetraphase, Theravance and Wockhardt.

MA had grants and speaker fees from Gilead, Merck, Novartis and Pfizer.

Acknowledgements

The lists of the colleagues who dedicated their time and participated in the questionnaire survey and of all those who participated in the ECIL-4 meeting are reported in Supporting Information file.

The authors would like to thank Jean-Michel Gosset and the staff of KOBE, group GL Events, Lyon, France, for the organization of the meeting.

These results have been presented during the ECIL-4 meeting in Juan-les-Pins, France, Sept 9–10th 2011.

References (59)

  • K.V. Rolston et al.

    The spectrum of Gram-positive bloodstream infections in patients with hematologic malignancies, and the in vitro activity of various quinolones against Gram-positive bacteria isolated from cancer patients

    Int J Infect Dis

    (2006)
  • E.M. Trecarichi et al.

    Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies

    J Infect

    (2009)
  • M. Tumbarello et al.

    Factors associated with mortality in bacteremic patients with hematologic malignancies

    Diagn Microbiol Infect Dis

    (2009)
  • D. Greenberg et al.

    Microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in paediatric febrile neutropenic oncology patients: comparison between two consecutive time periods with use of different antibiotic treatment protocols

    Int J Antimicrob Agents

    (2005)
  • E. Castagnola et al.

    Bloodstream infections and invasive mycoses in children undergoing acute leukaemia treatment: a 13-year experience at a single Italian institution

    Eur J Cancer

    (2005)
  • E. Castagnola et al.

    Differences in the proportions of fluoroquinolone-resistant Gram-negative bacteria isolated from bacteraemic children with cancer in two Italian centres

    Clin Microbiol Infect

    (2005)
  • EORTC International Antimicrobial Therapy Cooperative Group

    Gram-positive bacteraemia in granulocytopenic cancer patients

    Eur J Cancer

    (1990)
  • J. Klastersky

    Science and pragmatism in the treatment and prevention of neutropenic infection

    J Antimicrob Chemother

    (1998)
  • M. Ortega et al.

    Bacterial and fungal bloodstream isolates from 796 hematopoietic stem cell transplant recipients between 1991 and 2000

    Ann Hematol

    (2005)
  • B.A. Collin et al.

    Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients

    Clin Infect Dis

    (2001)
  • A.L. Oliveira et al.

    Epidemiology of bacteremia and factors associated with multi-drug-resistant Gram-negative bacteremia in hematopoietic stem cell transplant recipients

    Bone Marrow Transplant

    (2007)
  • K. Jacobson et al.

    Susceptibility surveillance among Gram-negative bacilli at a cancer center

    Chemotherapy

    (1999)
  • N.G. Almyroudis et al.

    Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients

    Transpl Infect Dis

    (2005)
  • P. Cappellano et al.

    Epidemiology and risk factors for bloodstream infections after allogeneic hematopoietic stem cell transplantation

    New Microbiol

    (2007)
  • M. Dettenkofer et al.

    Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project

    Clin Infect Dis

    (2005)
  • D.D. Poutsiaka et al.

    Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality

    Bone Marrow Transplant

    (2007)
  • E.M. Trecarichi et al.

    Multidrug resistant Pseudomonas aeruginosa bloodstream infection in adult patients with hematological malignancies

    Haematologica

    (2011)
  • A. Busca et al.

    Blood stream infections after allogeneic stem cell transplantation: a single-center experience with the use of levofloxacin prophylaxis

    Transpl Infect Dis

    (2011)
  • C. Cattaneo et al.

    Recent changes in bacterial epidemiology and the emergence of fluoroquinolone-resistant Escherichia coli among patients with haematological malignancies: results of a prospective study on 823 patients at a single institution

    J Antimicrob Chemother

    (2008)
  • Cited by (0)

    View full text