Molecular and Clinical Data of Antimicrobial Resistance in Microorganisms Producing Bacteremia in a Multicentric Cohort of Patients with Cancer in a Latin American Country

Cruz-Vargas, Sergio Andrés; García-Muñoz, Laura; Maldonado, Sonia Isabel Cuervo; Álvarez-Moreno, Carlos; Saavedra-Trujillo, Carlos H.; Alvarez-Rodríguez, José Camilo; Arango-Gutiérrez, Angélica; Gómez-Rincón, Julio César; García-Guzmán, Katherine; Leal, Aura Lucía; Garzón-Herazo, Javier; Martínez-Vernaza, Samuel; Guevara, Fredy Orlando; Jiménez-Cetina, Leydy Paola; Mora, Liliana Marcela; Saavedra, Sandra Yamile; Cortés, Jorge Alberto

doi:10.3390/microorganisms11020359

Cited by 6 publications

(1 citation statement)

References 45 publications

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“…Enterobacterales are the leading cause of bacteremia in high-risk neutropenic patients [ 1 , 2 , 3 , 4 ]. Likewise, growing antibiotic resistance is a major concern worldwide [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia

Herrera,

Torres,

Laborde

et al. 2024

Microorganisms

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Few studies have evaluated the efficacy of ceftazidime–avibactam (CA) for Klebsiella pneumoniae carbapenemase-producing Enterobacterales bacteremia (KPC-PEB) in high-risk neutropenic patients. This is a prospective multicenter observational study in high-risk neutropenic patients with multi-drug resistant Enterobacterales bacteremia. They were compared according to the resistance mechanism and definitive treatment provided: KPC-CPE treated with CA (G1), KPC-CPE treated with other antibiotics (G2), and patients with ESBL-producing Enterobacterales bacteremia who received appropriate definitive therapy (G3). Thirty-day mortality was evaluated using a logistic regression model, and survival was analyzed with Kaplan–Meier curves. A total of 238 patients were included: 18 (G1), 52 (G2), and 168 (G3). Klebsiella spp. (60.9%) and Escherichia coli (26.4%) were the Enterobacterales most frequently isolated, and 71% of the bacteremias had a clinical source. The resistance profile between G1 and G2 was colistin 35.3% vs. 36.5%, amikacin 16.7% vs. 40.4%, and tigeclycline 11.1% vs. 19.2%. The antibiotics prescribed in combination with G2 were carbapenems, colistin, amikacin, fosfomycin, tigecycline, and fluoroquinolones. Seven-day clinical response in G1 vs. G2 vs. G3 was 94.4% vs. 42.3% vs. 82.7%, respectively (p < 0.001). Thirty-day overall mortality in G1 vs. G2 vs. G3 was 22.2% vs. 53.8% vs. 11.9%, respectively (p < 0.001), and infection-related mortality was 5.5% vs. 51.9% vs. 7.7% (p < 0.001). The independent risk factors for mortality were Pitt score > 4: OR 3.63, 95% CI, 1.18–11.14 (p = 0.025) and KPC-PEB treated with other antibiotics: OR 8.85, 95% CI, 2.58–30.33 (p = 0.001), while 7-day clinical response was a protective factor for survival: OR 0.02, 95% CI, 0.01–0.08 (p < 0.001). High-risk neutropenic patients with KPC-CPE treated with CA had an outcome similar to those treated for ESBL-producing Enterobacterales, with higher 7-day clinical response and lower overall and infection-related mortality than those treated with other antibiotics. In view of these data, CA may be considered the preferred therapeutic option for KPC-PEB in high-risk neutropenic patients.

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“…Enterobacterales are the leading cause of bacteremia in high-risk neutropenic patients [ 1 , 2 , 3 , 4 ]. Likewise, growing antibiotic resistance is a major concern worldwide [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia

Herrera,

Torres,

Laborde

et al. 2024

Microorganisms

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Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm

Herrera,

Torres,

Laborde

et al. 2024

Eur J Clin Microbiol Infect Dis

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Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda

Lubwama,

Holte,

Zhang

et al. 2024

Open Forum Infectious Diseases

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Background We determined the etiology, risk factors and outcomes associated with bacteremia in patients with hematologic malignancies and febrile neutropenia (FN) at the Uganda Cancer Institute (UCI). Methods UCI adult and pediatric inpatients with hematologic malignancies and FN were prospectively enrolled and followed up to determine 30-day mortality. Blood drawn from participants with FN was cultured in the BACTEC 9120 blood culture system. Antimicrobial susceptibility testing was performed with the disk diffusion method on identified bacteria. Logistic regression and Cox proportional hazards regression were applied to estimate associations between participant characteristics and FN, bacteremia, and mortality. Results Of 495 participants, majority (N=306, 62%) were male. Median age was 23 years (IQR:11-42 years). Of the 132 participants who experienced FN, 43 (33%) had bacteremia. Participants with younger age (OR:0.98, p=0.05), severe neutropenia (OR: 2.9, p=0.01), hypotension (OR: 2.46, p=0.04), mucositis (OR: 2.77, p=0.01) and receiving chemotherapy (OR:2.25, p=0.03) were more likely to have bacteremia. Fifty (78%) bacteria isolated were Gram negative. E. coli (n=25, 50%) was predominant. Thirty-seven (86%) out of 43 episodes were caused by multidrug resistant (MDR) bacteria. 30-day overall survival for participants with bacteremia was significantly lower than that for participants with no bacteremia (p=0.05). MDR bacteremia (HR=1.84, p=0.05) was associated with increased risk of death. Conclusion Bacteremia was frequent in patients with hematologic cancer and FN and was associated with poor survival. MDR bacteria were the main cause of bacteremia and mortality. There is a need for robust infection control and antimicrobial stewardship programs in cancer centers in sub-Saharan Africa.

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Molecular and Clinical Data of Antimicrobial Resistance in Microorganisms Producing Bacteremia in a Multicentric Cohort of Patients with Cancer in a Latin American Country

Cited by 6 publications

References 45 publications

Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia

Ceftazidime–Avibactam Improves Outcomes in High-Risk Neutropenic Patients with Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales Bacteremia

Seven-day antibiotic therapy for Enterobacterales bacteremia in high-risk neutropenic patients: toward a new paradigm

Etiology, Risk Factors, and Outcomes of Bacteremia in Patients With Hematologic Malignancies and Febrile Neutropenia in Uganda

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