Monitoring antibiotic-resistant enterobacteria faecal levels is helpful in predicting antibiotic susceptibility of bacteraemia isolates in patients with haematological malignancies
Delay of active antimicrobial therapy in haematological patients with Gram-negative bacilli bacteraemia during profound neutropenia exposes them to increased morbidity and mortality. The digestive tract is the main source of enterobacteria causing bacteraemia in these patients. We thus evaluated the usefulness of broad-spectrum beta-lactam resistant enterobacteria (BSBL-RE) faecal shedding assessment in forecasting the susceptibility to BSBLs of the strains isolated from blood cultures. From 2002 to 2011, neutropenic haematological patients with bacteraemia caused by enterobacteria who had a stool culture during the previous 7 days were retrospectively included. BSBL-RE intestinal carriers were compared with non-carriers in terms of clinical and microbiological criteria. One hundred and four patients were included and 16 of them (15.4 %) were BSBL-RE carriers. Multivariate analysis showed that BSBL-RE carriage was independently associated with BSBL-RE identified in blood cultures (P < 0.001) and the use of carbapenems as empirical treatment of the bacteraemia (P = 0.008). Sensitivity, specificity, and the positive and negative predictive values of the test were 80 %, 91 %, 50 % and 98 %, respectively. Among the carriers, those with the highest level of BSBL-RE carriage were also those with the highest risk of bacteraemia due to BSBL-RE (P < 0.001). Close monitoring of BSBL-RE intestinal carriage may help to choose the most appropriate initial antimicrobial treatment for neutropenic haematological patients with bacteraemia.
AverbuchD.,
OraschC.,
CordonnierC.,
LivermoreD.M.,
MikulskaM.,
ViscoliC.,
GyssensI.C.,
KernW.V.,
KlyasovaG.,
other authors.
2013; European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 98:1826–1835[CrossRef]
BowE.J.2005; Management of the febrile neutropenic cancer patient: lessons from 40 years of study. Clin Microbiol Infect 11:(Suppl 5)24–29 [View Article][PubMed]
BowE.J.2013; There should be no ESKAPE for febrile neutropenic cancer patients: the dearth of effective antibacterial drugs threatens anticancer efficacy. J Antimicrob Chemother 68:492–495 [View Article][PubMed]
CantónR.,
AkóvaM.,
CarmeliY.,
GiskeC.G.,
GlupczynskiY.,
GniadkowskiM.,
LivermoreD.M.,
MiriagouV.,
NaasT.,
other authors.
2012; Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 18:413–431 [View Article][PubMed]
FreifeldA.G.,
BowE.J.,
SepkowitzK.A.,
BoeckhM.J.,
ItoJ.I.,
MullenC.A.,
RaadI.I.II,
RolstonK.V.,
YoungJ.A.,
other authors.
2011; Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 52:427–431 [View Article][PubMed]
FriedmanC.R.,
WhitneyC.G.2008; It's time for a change in practice: reducing antibiotic use can alter antibiotic resistance. J Infect Dis 197:1082–1083 [View Article][PubMed]
KimS.H.,
KwonJ.C.,
ChoiS.M.,
LeeD.G.,
ParkS.H.,
ChoiJ.H.,
YooJ.H.,
ChoB.S.,
EomK.S.,
other authors.
2013; Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome. Ann Hematol 92:533–541 [View Article][PubMed]
KwonJ.C.,
KimS.H.,
ChoiJ.K.,
ChoS.Y.,
ParkY.J.,
ParkS.H.,
ChoiS.M.,
LeeD.G.,
ChoiJ.H.,
YooJ.H.2013; Epidemiology and clinical features of bloodstream infections in hematology wards: one year experience at the catholic blood and marrow transplantation center. Infect Chemother 45:51–61 [View Article][PubMed]
LissB.J.,
VehreschildJ.J.,
CornelyO.A.,
HallekM.,
FätkenheuerG.,
WisplinghoffH.,
SeifertH.,
VehreschildM.J.2012; Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 40:613–619 [View Article][PubMed]
MicolJ.B.,
ChahineC.,
WoertherP.L.,
GhezD.,
NetzerF.,
DufourC.,
MeradM.,
BlotF.,
ChachatyE.,
other authors.
2014; Discontinuation of empirical antibiotic therapy in neutropenic acute myeloid leukaemia patients with fever of unknown origin: is it ethical?. Clin Microbiol Infect 20:O453–O455[PubMed][CrossRef]
OrtegaM.,
MarcoF.,
SorianoA.,
AlmelaM.,
MartínezJ.A.,
MuñozA.,
MensaJ.2009; Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother 63:568–574 [View Article][PubMed]
PizzoP.A.,
RobichaudK.J.,
GillF.A.,
WitebskyF.G.1982; Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 72:101–111 [View Article][PubMed]
WalshT.R.,
TolemanM.A.2012; The emergence of pan-resistant Gram-negative pathogens merits a rapid global political response. J Antimicrob Chemother 67:1–3 [View Article][PubMed]
WoertherP.L.,
BurdetC.,
ChachatyE.,
AndremontA.2013; Trends in human fecal carriage of extended-spectrum β-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev 26:744–758 [View Article][PubMed]
Monitoring antibiotic-resistant enterobacteria faecal levels is helpful in predicting antibiotic susceptibility of bacteraemia isolates in patients with haematological malignancies