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Long-term epidemiology of bacterial susceptibility profiles in adults suffering from febrile neutropenia with hematologic malignancy after antibiotic change.

Mebis J, Jansens H, Minalu G, Molenberghs G, Schroyens W, Gadisseur A, van de Velde A, Vrelust I, Goossens H, Berneman Z - Infect Drug Resist (2010)

Bottom Line: A reduced susceptibility of P. aeruginosa strains to meropenem was noticed.Improvement in antibiotic susceptibility of inducible Enterobacteriaceae following a switch of empiric antibiotic therapy was maintained 15 years after starting the latter treatment.Further improvement in antibiotic susceptibility of these bacteria to ceftazidime was observed, but continuous vigilance is warranted.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Antwerp University Hospital, Edegem.

ABSTRACT

Objective: The aim of this study was to investigate the epidemiology and antibiotic susceptibility profiles of isolated bacterial organisms in relation to empiric treatment of neutropenic fever over a 15-year period.

Methods: All patients with or at risk for febrile neutropenia and treated in the hematology ward of the Antwerp University Hospital during 1994-2008 were prospectively included. Skin, blood, and urine cultures were taken. Oral quinolone prophylaxis was started in patients with neutropenia without fever. Empiric starting therapy consisted of amikacin in combination with cefepime.

Results: A total of 3624 bacteria were isolated. The most common pathogens were coagulase-negative Staphylococci (46%), followed by Escherichia coli (25%), Enterobacteriaceae (15.6%), Staphylococcus aureus (7.2%), and Pseudomonas aeruginosa (3.8%). The balance between Gram-positive and Gram-negative bacteria remained stable, with a majority of Gram-positive bacteria. A shift from oxacillin-sensitive to oxacillin-resistant coagulase-negative Staphylococci was observed. Regarding susceptibility patterns, no vancomycin resistance was detected in coagulase-negative Staphylococci or in S. aureus. The E. coli susceptibility rates remained stable. However, 66% of bloodstream infections were ciprofloxacin-resistant. A reduced susceptibility of P. aeruginosa strains to meropenem was noticed.

Conclusions: Improvement in antibiotic susceptibility of inducible Enterobacteriaceae following a switch of empiric antibiotic therapy was maintained 15 years after starting the latter treatment. Further improvement in antibiotic susceptibility of these bacteria to ceftazidime was observed, but continuous vigilance is warranted.

No MeSH data available.


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Isolated Gram-positive bacteria in all cultures (1994–2008).Abbreviations: MRSA, Methicillin-resistant S. Aureus; MSSA, Methicillin-sensitive S. Aureus; CNS oxa R, CNS oxacillin-resistant; CNS oxa S, CNS oxacillin-sensitive.
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f2-idr-3-053: Isolated Gram-positive bacteria in all cultures (1994–2008).Abbreviations: MRSA, Methicillin-resistant S. Aureus; MSSA, Methicillin-sensitive S. Aureus; CNS oxa R, CNS oxacillin-resistant; CNS oxa S, CNS oxacillin-sensitive.

Mentions: S. aureus was isolated in 262 (7.2%) cases. Only 48 isolates (1.3%) were methicillin-resistant (Figure 2). There was a significant decrease in S. aureus isolates (P <0.0001) throughout the study period. Among the Gram-negative bacteria, the majority were Escherichia coli (n = 910, 25%). A significant decrease in isolates was seen (P = 0.0006). Enterobacteriaceae was isolated in 567 (15.6%) cases. Of these, 306 isolates were inducible Enterobacteriaceae (Enterobacter spp, Serratia spp, Morganella morganii, Citrobacter spp, Providencia spp, and Pantoea agglomerans, 8.4%). A significant decrease over time of inducible Enterobacteriaceae was noted (P = 0.0027). Pseudomonas aeruginosa was isolated in 140 (3.8%) cases (Figure 3).


Long-term epidemiology of bacterial susceptibility profiles in adults suffering from febrile neutropenia with hematologic malignancy after antibiotic change.

Mebis J, Jansens H, Minalu G, Molenberghs G, Schroyens W, Gadisseur A, van de Velde A, Vrelust I, Goossens H, Berneman Z - Infect Drug Resist (2010)

Isolated Gram-positive bacteria in all cultures (1994–2008).Abbreviations: MRSA, Methicillin-resistant S. Aureus; MSSA, Methicillin-sensitive S. Aureus; CNS oxa R, CNS oxacillin-resistant; CNS oxa S, CNS oxacillin-sensitive.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108744&req=5

f2-idr-3-053: Isolated Gram-positive bacteria in all cultures (1994–2008).Abbreviations: MRSA, Methicillin-resistant S. Aureus; MSSA, Methicillin-sensitive S. Aureus; CNS oxa R, CNS oxacillin-resistant; CNS oxa S, CNS oxacillin-sensitive.
Mentions: S. aureus was isolated in 262 (7.2%) cases. Only 48 isolates (1.3%) were methicillin-resistant (Figure 2). There was a significant decrease in S. aureus isolates (P <0.0001) throughout the study period. Among the Gram-negative bacteria, the majority were Escherichia coli (n = 910, 25%). A significant decrease in isolates was seen (P = 0.0006). Enterobacteriaceae was isolated in 567 (15.6%) cases. Of these, 306 isolates were inducible Enterobacteriaceae (Enterobacter spp, Serratia spp, Morganella morganii, Citrobacter spp, Providencia spp, and Pantoea agglomerans, 8.4%). A significant decrease over time of inducible Enterobacteriaceae was noted (P = 0.0027). Pseudomonas aeruginosa was isolated in 140 (3.8%) cases (Figure 3).

Bottom Line: A reduced susceptibility of P. aeruginosa strains to meropenem was noticed.Improvement in antibiotic susceptibility of inducible Enterobacteriaceae following a switch of empiric antibiotic therapy was maintained 15 years after starting the latter treatment.Further improvement in antibiotic susceptibility of these bacteria to ceftazidime was observed, but continuous vigilance is warranted.

View Article: PubMed Central - PubMed

Affiliation: Division of Hematology, Antwerp University Hospital, Edegem.

ABSTRACT

Objective: The aim of this study was to investigate the epidemiology and antibiotic susceptibility profiles of isolated bacterial organisms in relation to empiric treatment of neutropenic fever over a 15-year period.

Methods: All patients with or at risk for febrile neutropenia and treated in the hematology ward of the Antwerp University Hospital during 1994-2008 were prospectively included. Skin, blood, and urine cultures were taken. Oral quinolone prophylaxis was started in patients with neutropenia without fever. Empiric starting therapy consisted of amikacin in combination with cefepime.

Results: A total of 3624 bacteria were isolated. The most common pathogens were coagulase-negative Staphylococci (46%), followed by Escherichia coli (25%), Enterobacteriaceae (15.6%), Staphylococcus aureus (7.2%), and Pseudomonas aeruginosa (3.8%). The balance between Gram-positive and Gram-negative bacteria remained stable, with a majority of Gram-positive bacteria. A shift from oxacillin-sensitive to oxacillin-resistant coagulase-negative Staphylococci was observed. Regarding susceptibility patterns, no vancomycin resistance was detected in coagulase-negative Staphylococci or in S. aureus. The E. coli susceptibility rates remained stable. However, 66% of bloodstream infections were ciprofloxacin-resistant. A reduced susceptibility of P. aeruginosa strains to meropenem was noticed.

Conclusions: Improvement in antibiotic susceptibility of inducible Enterobacteriaceae following a switch of empiric antibiotic therapy was maintained 15 years after starting the latter treatment. Further improvement in antibiotic susceptibility of these bacteria to ceftazidime was observed, but continuous vigilance is warranted.

No MeSH data available.


Related in: MedlinePlus