Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

被引：190

作者：

Averbuch, Diana ^{[1
]}

Tridello, Gloria ^{[2
]}

Hoek, Jennifer ^{[3
]}

Mikulska, Malgorzata ^{[4
]}

Akan, Hamdi ^{[5
]}

Yanez San Segundo, Lucrecia ^{[6
]}

Pabst, Thomas ^{[7
]}

Ozcelik, Tulay ^{[8
]}

Klyasova, Galina ^{[9
]}

Donnini, Irene ^{[10
]}

Wu, Depei ^{[11
]}

Gulbas, Zafer ^{[12
]}

Zuckerman, Tsila ^{[13
]}

de Sousa, Aida Botelho ^{[14
]}

Beguin, Yves ^{[15
]}

Xhaard, Alienor ^{[16
]}

Bachy, Emmanuel ^{[17
]}

Ljungman, Per ^{[18
,19
]}

de la Camara, Rafael ^{[20
]}

Rascon, Jelena ^{[21
]}

Ruiz Camps, Isabel ^{[22
]}

Vitek, Antonin ^{[23
]}

Patriarca, Francesca ^{[24
]}

Cudillo, Laura ^{[25
]}

Vrhovac, Radovan ^{[26
]}

Shaw, Peter J. ^{[27
]}

Wolfs, Tom ^{[28
]}

O'Brien, Tracey ^{[29
]}

Avni, Batia ^{[1
]}

Silling, Gerda ^{[30
]}

Al Sabty, Firas ^{[31
]}

Graphakos, Stelios ^{[32
]}

Sankelo, Marja ^{[33
]}

Sengeloev, Henrik ^{[34
]}

Pillai, Srinivas ^{[35
]}

Matthes, Susanne ^{[36
]}

Melanthiou, Frederiki ^{[37
]}

Iacobelli, Simona ^{[25
]}

Styczynski, Jan ^{[38
]}

Engelhard, Dan ^{[1
]}

Cesaro, Simone ^{[2
]}

机构：

[1] Hadassah Univ Hosp, Jerusalem, Israel

[2] Azienda Osped Univ Integrata, Pediat Hematol Oncol, Verona, Italy

[3] European Bone Marrow Transplantat Data Off, Leiden, Netherlands

[4] Osped San Martino Genova, Genoa, Italy

[5] Ankara Univ, Fac Med, Ankara, Turkey

[6] Hosp Univ Marques de Valdecilla, Santander, Spain

[7] Univ Hosp, Bern, Switzerland

[8] Florence Nightingale Sisli Hosp, Istanbul, Turkey

[9] Natl Res Ctr Hematol, Moscow, Russia

[10] Azienda Osped Univ Careggi, Florence, Italy

[11] Soochow Univ, Affiliated Hosp 1, Suzhou, Jiangsu, Peoples R China

[12] Anadolu Med Ctr Hosp, Kocaeli, Turkey

[13] Rambam Med Ctr, Haifa, Israel

[14] Hosp Capuchos, Lisbon, Portugal

[15] Univ Liege, Liege, Belgium

[16] Hosp St Louis, Paris, France

[17] Hosp Civils Lyon, Ctr Hosp Lyon Sud, Lyon, France

[18] Karolinska Univ Hosp, Stockholm, Sweden

[19] Karolinska Inst, Stockholm, Sweden

[20] Hosp Princesa, Madrid, Spain

[21] Univ Hosp Santariskiu Klinikos, Vilnius, Lithuania

[22] Hosp Valle De Hebron, Barcelona, Spain

[23] Inst Hematol & Blood Transfus, Prague, Czech Republic

[24] Azienda Osped Univ, Udine, Italy

[25] Tor Vergata Univ, Rome, Italy

[26] Univ Hosp Ctr Rebro, Zagreb, Croatia

[27] Childrens Hosp, Westmead, NSW, Australia

[28] Univ Hosp Children, Utrecht, Netherlands

[29] Sydney Childrens Hosp, Randwick, NSW, Australia

[30] Univ Munster, Munster, Germany

[31] Univ Hosp, Bratislava, Slovakia

[32] St Sophia Childrens Hosp, Athens, Greece

[33] Tampere Univ Hosp, Tampere, Finland

[34] Rigshosp, Copenhagen, Denmark

[35] Univ Hosp North Staffordshire, Stoke On Trent, England

[36] St Anna Childrens Hosp, Vienna, Austria

[37] Nicosia Gen Hosp, Nicosia Strovolos, Cyprus

[38] Nicolaus Copernicus Univ Torun, Coll Med, Bydgoszcz, Poland

来源：

CLINICAL INFECTIOUS DISEASES | 2017年 / 65卷 / 11期

关键词：

antimicrobial resistance; gram-negative rods; hematopoietic stem cell transplantation; bacteremia; BLOOD-STREAM INFECTIONS; NEUTROPENIC PATIENTS; KLEBSIELLA-PNEUMONIAE; RISK-FACTORS; MULTICENTER; CARBAPENEM; CANCER; ENTEROBACTERIACEAE; PROPHYLAXIS; THERAPY;

D O I：

10.1093/cid/cix646

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Data from a prospective intercontinental study of resistance in gram-negative rods causing bacteremia in hematopoietic stem cell transplant recipients challenge current approach to fluoroquinolone prophylaxis and call for reassessment of local empiric antibiotic protocols. Knowledge of pathogen-specific resistances enables early appropriate empiric therapy.This intercontinental study aimed to study gram-negative rod (GNR) resistance in hematopoietic stem cell transplantation (HSCT). GNR bacteremias occurring during 6 months post-HSCT (February 2014-May 2015) were prospectively collected, and analyzed for rates and risk factors for resistance to fluoroquinolones, noncarbapenem anti-Pseudomonas beta-lactams (noncarbapenems), carbapenems, and multidrug resistance. Sixty-five HSCT centers from 25 countries in Europe, Australia, and Asia reported data on 655 GNR episodes and 704 pathogens in 591 patients (Enterobacteriaceae, 73%; nonfermentative rods, 24%; and 3% others). Half of GNRs were fluoroquinolone and noncarbapenem resistant; 18.5% carbapenem resistant; 35.2% multidrug resistant. The total resistance rates were higher in allogeneic HSCT (allo-HSCT) vs autologous HSCT (auto-HSCT) patients (P < .001) but similar in community-acquired infections. Noncarbapenem resistance and multidrug resistance were higher in auto-HSCT patients in centers providing vs not providing fluoroquinolone prophylaxis (P < .01). Resistance rates were higher in southeast vs northwest Europe and similar in children and adults, excluding higher fluoroquinolone- and beta-lactam/beta-lactamase inhibitor resistance rates in allo-HSCT adults. Non-Klebsiella Enterobacteriaceae were rarely carbapenem resistant. Multivariable analysis revealed resistance risk factors in allo-HSCT patients: fluoroquinolone resistance: adult, prolonged neutropenia, breakthrough on fluoroquinolones; noncarbapenem resistance: hospital-acquired infection, breakthrough on noncarbapenems or other antibiotics (excluding fluoroquinolones, noncarbapenems, carbapenems), donor type; carbapenem resistance: breakthrough on carbapenem, longer hospitalization, intensive care unit, previous other antibiotic therapy; multidrug resistance: longer hospitalization, breakthrough on beta-lactam/beta-lactamase inhibitors, and carbapenems. Inappropriate empiric therapy and mortality were significantly more common in infections caused by resistant bacteria. Our data question the recommendation for fluoroquinolone prophylaxis and call for reassessment of local empiric antibiotic protocols. Knowledge of pathogen-specific resistance enables early appropriate empiric therapy. Monitoring of resistance is crucial. NCT02257931.

引用

页码：1819 / 1828

页数：10

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