Abstract
BackgroundInfection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies.MethodsWe conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance.ResultsIn total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare.ConclusionsBroad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.
Highlights
Infection is a major complication for patients with haematological malignancies
Some studies have reported the emergence of broad-spectrum antibiotic-resistant bacteria, including multidrug-resistant Pseudomonas aeruginosa (MDRP) and Acinetobacter spp. (MDRA), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRP), third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumonia, and methicillin-resistant Staphylococcus aureus (MRSA) [6,7,8,9]
To analyse bacterial and antimicrobial susceptibility, we used the results of susceptibility tests based on the Japan Nosocomial Infections Surveillance (JANIS) programme conducted by the Ministry of Health, Labour and Welfare on the prevalence of antibiotic-resistant bacteria, using data from multiple hospitals [17, 25]
Summary
Infection is a major complication for patients with haematological malignancies. Very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. (MDRA), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRP), third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumonia, and methicillin-resistant Staphylococcus aureus (MRSA) [6,7,8,9]. These antibiotic-resistant strains have become a significant threat to cancer patients [9,10,11,12]. MRSA has been the most prevalent AMR bacteria since 2008 [17]
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