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An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality

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Abstract

Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum β-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.

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Abbreviations

FN:

febrile neutropenia

BSIs:

bloodstream infections

ESBL:

extended-spectrum β-lactamases

MDR:

multi-drug resistant

FNPs:

febrile neutropenic patients

ANC:

absolute neutrophil count

CoNS :

coagulase-negative staphylococci

EUCAST:

European Committee on Antimicrobial Susceptibility Testing

HSCR:

hematopoietic stem cell recipients

AML:

acute myeloid leukemia

ALL:

acute lymphocytic leukemia

ECIL:

European Conference on Infections in Leukemia

CRE:

carbapenem-resistant Enterobacteriaceae

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Authors and Affiliations

  1. Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098, Istanbul, Turkey

    Ritvan Kara Ali, Serkan Surme, Ilker Inanc Balkan, Meryem Sahin Ozdemir, Yusuf Ozdemir, Bilgul Mete, Fehmi Tabak & Nese Saltoglu

  2. Department of Hematology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey

    Ayse Salihoglu & Muhlis Cem Ar

  3. Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey

    Gunay Can

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  1. Ritvan Kara Ali
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Correspondence to Serkan Surme.

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Kara Ali, R., Surme, S., Balkan, I.I. et al. An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality. Ann Hematol 99, 1925–1932 (2020). https://doi.org/10.1007/s00277-020-04144-w

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