1. Resistance to empirical β-lactams recommended in febrile neutropenia guidelines in Gram-negative bacilli bloodstream infections in Spain: a multicentre study.
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Chumbita, Mariana, Puerta-Alcalde, Pedro, Yáñez, Lucrecia, Cuesta, Maria Angeles, Chinea, Anabelle, Morales, Ignacio Español, Abellán, Pascual Fernández, Gudiol, Carlota, Guerreiro, Manuel, González-Sierra, Pedro, Rojas, Rafael, Pina, José María Sánchez, Vadillo, Irene Sánchez, Varela, Rosario, Vázquez, Lourdes, Lopera, Carlos, Monzó, Patricia, Garcia-Vidal, Carolina, Español Morales, Ignacio, and Fernández Abellán, Pascual
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ANTIBIOTICS , *BACTEREMIA , *RESEARCH , *BETA lactam antibiotics , *GRAM-negative bacteria , *RESEARCH methodology , *NEUTROPENIA , *RETROSPECTIVE studies , *EVALUATION research , *SEPSIS , *COMPARATIVE studies , *IMPACT of Event Scale , *RESEARCH funding , *GRAM-negative bacterial diseases , *PSEUDOMONAS , *BRIEF Symptom Inventory , *LONGITUDINAL method - Abstract
Objectives: To describe current resistance to the β-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 β-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 β-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. [ABSTRACT FROM AUTHOR]- Published
- 2022
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