Changing microbial epidemiology in hematopoietic stem cell transplant recipients: increasing resistance over a 9‐year period. Issue 6 (9th October 2014)

• Record Type: Journal Article
• Authors: Macesic, N.; Morrissey, C.O.; Cheng, A.C.; Spencer, A.; Peleg, A.Y.
• Is Part Of: Transplant infectious disease. Volume 16:Issue 6(2014)
• Page Start: 887
• Page End: 896
• Publication Date: 2014-10-09
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12298
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12298-abs-0001"> <title>Abstract</title> <sec id="tid12298-sec-0001" sec-type="section"> <p>Infections remain important contributors to mortality in hematopoietic stem cell transplantation (HSCT).</p> </sec> <sec id="tid12298-sec-0002" sec-type="section"> <title>Method</title> <p>We studied the evolving epidemiology and trends in susceptibility of bacterial and <italic>Candida</italic> isolates at an Australian HSCT center. A total of 528 HSCTs in 508 patients were performed from April 2001 to May 2010. A total of 605 isolates were eligible for study inclusion; 318 (53%) were gram‐positive, 268 (44%) were gram‐negative, and 19 (3%) were <italic>Candida</italic> species.</p> </sec> <sec id="tid12298-sec-0003" sec-type="section"> <title>Results</title> <p>The most common site for isolates was blood (380 isolates, 63%). <italic>Staphylococcus aureus</italic> was the most common gram‐positive organism (<italic>n</italic> = 107, 34%), but trends to increasing coagulase‐negative staphylococci (<italic>P</italic> = 0.002) and vancomycin‐resistant <italic>Enterococcus</italic> (<italic>P</italic> < 0.001) were observed. <italic>Escherichia coli</italic> was the most common gram‐negative isolate (<italic>n</italic> = 74, 28%). Fluoroquinolone resistance increased with widespread use of protocol fluoroquinolone prophylaxis (<italic>P</italic> = 0.001). Carbapenem resistance was found in 44% of <italic>Pseudomonas</italic> or <italic>Acinetobacter</italic> isolates. Bloodstream infection with a multidrug‐resistant organism (odds ratio 3.61, 95% confidence interval: 1.40–9.32, <italic>P</italic> = 0.008) was an independent predictor of mortality at 7 days after a positive blood culture.</p> </sec> <sec id="tid12298-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Antimicrobial resistance is an increasing problem in this vulnerable patient population, and not only has an impact on choice of empiric therapy for febrile neutropenia but also on mortality.</p> </sec> </abstract>