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Abstract
BackgroundCarbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy.MethodsWe reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital.ResultsAmong 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3–284.1; P < 0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4–112.5; P = 0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1–1.2; P < 0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0–14.8; P < 0.001).ConslusionCarba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.
Highlights
Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients
Clinical characteristics We retrieved clinical data from electronic medical records related to patient characteristics, including: age, sex, purpose of chemotherapy, history of diabetes mellitus, history of a resistant organism colonization in the preceding year (namely, vancomycin-resistant enterococci (VRE), extendedspectrum β-lactamase-producing enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (CRAB)), history of GNB bacteremia in the prior year, primary site of infection, the acute severity of sepsis measured with the Pitt bacteremia score [11, 12], the presence of septic shock, antibiotics used at bacteremia onset and those used empirically before the antibiotic susceptibility results become available, and the hospitalization duration before the GNB bacteremia onset
Carbapenems cover a broad spectrum of gram-negative bacteria, 9.2% of GNB bacteremia cases were due to carba-NS isolates in this study
Summary
Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. We explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. Bloodstream infections caused by gram negative bacilli (GNB) are a major cause of morbidity and mortality in patients with acute myelogenous leukemia (AML) that undergo induction or consolidation chemotherapy [4, 5]. Appropriate treatment might be delayed when pathogens are not susceptible to carbapenem (carba-NS), which could lead to a poor clinical outcome [9, 10]. No study has elucidated risk factors in patients with AML that receive chemotherapy
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