Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy: an 11-year multi-centre retrospective study

Court, J.R. de la; Woudt, S.H.S.; Schoffelen, A.F.; Heijmans, J.; Jonge, N.A. de; Bruggen, T. van der; ... ; Schade, R.P. (2022)

Article / Letter to editor

Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization. Methods Using 11 years of data (2008-2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates). Results We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate. Conclusions This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.

• Febrile neutropenia
• Antimicrobial resistance
• Resistance surveillance
• Empirical antibiotic therapy
• Third-generation-cephalosporin resistance
• Colonization

• All authors: Court, J.R. de la; Woudt, S.H.S.; Schoffelen, A.F.; Heijmans, J.; Jonge, N.A. de; Bruggen, T. van der; Bomers, M.K.; Lambregts, M.M.C.; Schade, R.P.
• Date: 2022-11-28
• Journal: Annals of Clinical Microbiology and Antimicrobials
• Volume: 21
• Issue: 1
• DOI: doi:10.1186/s12941-022-00544-0
• Link: https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-022-005...