Epidemiology and emerging resistance in bacterial bloodstream infections in patients with hematologic malignancies. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Kara, Özgür; Zarakolu, Pinar; Aşçioğlu, Sibel; Etgül, Sezgin; Uz, Burak; Büyükaşik, Yahya; Akova, Murat
• Is Part Of: Infectious diseases. Volume 47:Issue 10(2015:Oct.)
• Page Start: 690
• Page End: 697
• Publication Date: 2015-10
• Subjects: Bloodstream infection -- bacteremia -- hematologic malignancy -- neutropenia -- antimicrobial resistance; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.3109/23744235.2015.1051105
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Background: The objective of this study was determine the frequency of bloodstream infections (BSIs) and the causative bacteria and their resistance patterns in patients with hematological malignancies (HMs) in a large tertiary care university hospital in Turkey over a 5-year period. Methods: A total of 2098 patients with HMs with 3703 neutropenic episodes were included. Patients were classified as high-risk ( n = 843) and low-risk ( n = 1255) groups and evaluated for frequency of BSIs, causative bacteria, and their resistance patterns. Results: The frequency of BSIs was 14.5%. The frequency of gram-negative BSIs in high-risk and low-risk groups was 10.7% and 5.4% ( p < 0.001), respectively. The frequency of gram-positive BSIs in high-risk and low-risk groups was 7.0% and 3.9% ( p < 0.001), respectively. Gram-negative bacteria predominated (52.6%), with Escherichia coli (17.3%) and Klebsiella spp. (11.0%) as the most frequent organisms. Coagulase-negative staphylococci (10.4%) and Corynebacterium spp. (6.3%) were the most common gram-positive bacteria (35.8%). The rate of extended-spectrum beta-lactamase (ESBL) production was 45% for E. coli and 58% for Klebsiella spp. Quinolone resistance was 58% for E. coli and 11% for Klebsiella spp.. The overall frequency of ceftazidime resistance in Pseudomonas aeruginosa was 28%, and 87% of Acinetobacter spp. were multidrug-resistant. Of Staphylococcus aureus isolates, 24.8% were resistant to methicillin. Conclusion: The dominating causes of BSIs in patients with HMs in our hospital are resistant gram-negative bacteria, which has made empirical antimicrobial choice a highly challenging issue in this patient population.