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Abstract: Objectives: To describe current resistance to the ?-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 ?-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 ?-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.
Fuente: J Antimicrob Chemother . 2022 Jun 29;77(7):2017-2023
Publisher: Oxford University Press
Year of publication: 2022
No. of pages: 7
Publication type: Article
DOI: 10.1093/jac/dkac135
ISSN: 0305-7453,1460-2091
Publication Url: https://www.doi.org/10.1093/jac/dkac135
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CHUMBITA, MARIANA
PUERTA-ALCALDE, PEDRO
LUCRECIA YAÑEZ SAN SEGUNDO
CUESTA, MARIA ANGELES
CHINEA, ANABELLE
ESPAÑOL MORALES, IGNACIO
FERNÁNDEZ ABELLÁN, PASCUAL
GUDIOL, CARLOTA
GUERREIRO, MANUEL
GONZÁLEZ-SIERRA, PEDRO
ROJAS, RAFAEL
SÁNCHEZ PINA, JOSÉ MARÍA
SÁNCHEZ VADILLO, IRENE
VARELA, ROSARIO
VÁZQUEZ, LOURDES
LOPERA, CARLOS
MONZÓ, PATRICIA
GARCIA-VIDAL, CAROLINA
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