Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study

Abstract

Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization. Methods Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates). Results We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate. Conclusions This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.

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

“…Among the microorganisms identified, an acquired resistance profile was found in 63% of the isolates, in agreement with recent studies that have shown a gradual increase in antimicrobial resistance; among the proposed mechanisms, selective pressure due to inadequate use of antibiotics has been considered [ 22 , 25 ]. In South Korea, Nham et al found a relationship between the development of BLEE-producing K. pneumoniae and the previous use of antimicrobials [ 20 ], without ruling out cross-bacterial transmission in different institutions, especially in those with low antimicrobial use, and the introduction of resistant bacteria from the community [ 26 ].…”

Identification of a novel CG307 sub-clade in third-generation-cephalosporin-resistant Klebsiella pneumoniae causing invasive infections in the USA

“…It is worth noting that given we only sampled 3GC-R K. pneumoniae isolates collected from bacteraemia infections, we are likely underestimating the true scope of transmission that could be occurring at our institution. Interestingly, transmission clusters almost exclusively were due to the ‘problem clones’ CG307 and CG29 (), and involved patients with haematological malignancy, likely because of the propensity of such individuals to develop bacteraemias following initial colonization [58]. Outbreaks of these two global problem clones have been described [59], although whether such transmission is happening due to direct human contact or being acquired from the hospital environment is not currently known.…”

Identification of A Novel CG307 Sub-clade in Third Generation Cephalosporin ResistantKlebsiella pneumoniaeCausing Invasive Infections in the United States

“…Interestingly, transmission clusters almost exclusively were due to the "problem clones" CG307 and CG29 (Fig. 4A) and involved patients with hematologic malignancy, likely because of the propensity of such individuals to develop bacteremias following initial colonization [59]. Outbreaks of these two "global problem clones" have been described [60] although whether such transmission is happening due to direct human contact or being acquired from the hospital environment is not currently known.…”