Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey.
Trecarichi Enrico Maria,Giuliano Gabriele,Cattaneo Chiara,Ballanti Stelvio,Criscuolo Marianna,Candoni Anna,Marchesi Francesco,Laurino Marica,Dargenio Michelina,Fanci Rosa,Cefalo Mariagiovanna,Delia Mario,Spolzino Angelica,Maracci Laura,Nadali Gianpaolo,Busca Alessandro,Del Principe Maria Ilaria,Daffini Rosa,Simonetti Edoardo,Dragonetti Giulia,Zannier Maria Elena,Pagano Livio,Tumbarello Mario,
PloS one
Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.
10.1371/journal.pone.0224465
Detection of bacteria in blood circulation in patients receiving cancer chemotherapy.
Ota Akiko,Morita Sachi,Matsuoka Ayumu,Shimokata Tomoya,Maeda Osamu,Mitsuma Ayako,Yagi Tetsuya,Asahara Takashi,Ando Yuichi
International journal of clinical oncology
INTRODUCTION:Bacterial translocation, in which intestinal bacteria pass through the intestinal wall, enter the blood circulation, and spread to other sites of the body, is thought to cause bacteremia and sometimes febrile neutropenia (FN) in patients who receive cancer chemotherapy. MATERIALS AND METHODS:We collected blood samples from 39 patients with various cancers at baseline and after chemotherapy began (during chemotherapy) and explored how frequently bacteria could be detected in the blood using a highly-sensitive, bacterial rRNA-targeted reverse transcription quantitative polymerase chain reaction (PCR) assay. RESULTS:Bacterial traces, typically Escherichia coli and Enterobacter spp., were detected in 10 patients (25.6%) at baseline and 11 patients (28.2%) during chemotherapy. The bacterial traces were positive either at baseline or during chemotherapy in 3 (60%) of 5 patients who had FN, and 6 (46%) of 13 patients aged 65 years or older. CONCLUSION:These findings support the notion that bacterial translocation occurs in patients with cancer regardless of whether they receive chemotherapy and can lead to the development of FN and other treatment-related infections.
10.1007/s10147-019-01521-y
Impact of neutropenia on central venous catheter-related bloodstream infections in patients with hematological malignancies at the time of central venous catheter insertion: A matched-pair analysis.
Tölle Daniela,Hentrich Marcus,Pelzer Benedikt W,Kremer Pierre,Einhell Sabine,Schulz Sebastian,Böll Boris,Panse Jens,Schmidt-Hieber Martin,Teschner Daniel,Schalk Enrico
Infection control and hospital epidemiology
10.1017/ice.2019.224
A therapeutic benefit of daptomycin against glycopeptide-resistant gram-positive cocci bloodstream infections under neutropenia.
Matsuda Kensuke,Koya Junji,Toyama Kazuhiro,Ikeda Mahoko,Arai Shunya,Nakamura Fumihiko,Okugawa Shu,Moriya Kyoji,Kurokawa Mineo
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
Antibiotic-resistant infections remain to be a major issue for all over the world. Although appropriate diagnosis and rapid treatment initiation are crucially important particularly in immunocompromised patients, selection of antibiotics without identification of causative bacteria is often challenging. A 44-year-old woman with acute myeloid leukemia (AML) under myelosuppression suffered from teicoplanin-resistant gram-positive cocci bacteremia. Taking severe neutropenia due to chemotherapy and glycopeptide-resistance into account, teicoplanin was empirically substituted with daptomycin, which led to prompt defervescence. This microorganism later turned out to be Leuconostoc lactis (L. Lactis), and daptmycin was continued to use based on antimicrobial susceptibility tests. As a result, empiric use of daptomycin successfully controlled glycopeptide-resistant gram-positive cocci bacteremia under neutropenia. This is the first report of daptomycin treatment for L. lactis bacteremia in a patient with AML under neutropenia. Our findings suggest that daptomycin would be a suitable treatment option for glycopeptide-resistant gram-positive cocci bloodstream infections, especially in myelosuppressive patients.
10.1016/j.jiac.2017.06.010
Clinical and microbiological characteristics of bloodstream infections among patients with haematological malignancies with and without neutropenia at a medical centre in northern Taiwan, 2008-2013.
Chen Chien-Yuan,Tien Feng-Ming,Sheng Wang-Huei,Huang Shang-Yi,Yao Ming,Tang Jih-Luh,Tsay Woei,Tien Hwei-Fang,Hsueh Po-Ren
International journal of antimicrobial agents
This study aimed to investigate the epidemiology and microbiology of bloodstream infections (BSIs) in patients with haematological malignancies. Clinical characteristics and microbiology of 2083 patients with haematological malignancy who were treated for BSI from 2008 to 2013 at a medical centre in Taiwan were retrospectively reviewed. Lymphoma (38.1%) was the most common, followed by acute myeloid leukaemia (30.9%). Of the 2090 non-duplicate BSI isolates, 1310 (62.7%) were recovered from patients with neutropenia. Of the Gram-negatives (53.7%), Escherichia coli was predominant (13.8%), followed by Klebsiella pneumoniae (9.5%), Acinetobacter calcoaceticus-baumannii (ACB) complex (5.7%) and Pseudomonas aeruginosa (4.0%). Of the Gram-positives (40.2%), coagulase-negative staphylococci were the most common (20.5%), followed by Enterococcus faecium (5.6%). Candida tropicalis (2.0%) was the most commonly encountered yeast (5.0%). Multidrug resistance (MDR) was identified in 21.8% of ACB complex isolates. Among the 57 Staphylococcus aureus isolates, 24 (42.1%) were resistant to oxacillin (MRSA), and among the 118 E. faecium isolates, 55 (46.6%) were resistant to vancomycin (VRE). The overall 14-day mortality rate was 12.9% (n = 269). There was no significant difference in 14-day mortality among patients with (13.4%) and without (11.9%) neutropenia (P = 0.315). Multivariate analysis revealed that age ≥60 years, prior allogeneic transplantation, BSI due to VRE (E. faecium) and shock were independent predictors of 14-day mortality. Gram-negative organisms continued to be the most common cause of BSI in patients with haematological malignancies during the period 2008-2013. There was a significant increase in the prevalence of VRE (E. faecium) and MDR-ACB complex isolates.
10.1016/j.ijantimicag.2016.11.009
Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia.
Gudiol Carlota,Royo-Cebrecos Cristina,Abdala Edson,Akova Murat,Álvarez Rocío,Maestro-de la Calle Guillermo,Cano Angela,Cervera Carlos,Clemente Wanessa T,Martín-Dávila Pilar,Freifeld Alison,Gómez Lucía,Gottlieb Thomas,Gurguí Mercè,Herrera Fabián,Manzur Adriana,Maschmeyer Georg,Meije Yolanda,Montejo Miguel,Peghin Maddalena,Rodríguez-Baño Jesús,Ruiz-Camps Isabel,Sukiennik Teresa C,Tebe Cristian,Carratalà Jordi,
Antimicrobial agents and chemotherapy
β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients). The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients.
10.1128/AAC.00164-17
Associated factors and clinical outcomes of bloodstream infection due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae during febrile neutropenia.
Ben-Chetrit Eli,Eldaim Mustafa Abed,Bar-Meir Maskit,Dodin Mutaz,Katz David E
International journal of antimicrobial agents
Patients with neutropenia are vulnerable to serious infections. During the last decade, increased prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae has affected immunocompromised patients. We conducted a single-center case-control study to evaluate factors associated with ESBL-positive bacteremia among neutropenic patients, and its clinical impact. The study included adult patients with hematologic or oncologic diseases diagnosed with ESBL-positive and ESBL-negative Escherichia coli or Klebsiella pneumoniae bacteremia during febrile neutropenia between January 2010 and October 2017 at the Shaare Zedek Medical Center, Jerusalem, Israel. Analyses included risk factors for ESBL-positive bacteremia, appropriateness of empiric antibiotics, mortality, length of stay, and intensive care unit (ICU) admission. Univariate and multivariate models were constructed. The cohort (80 patients), consisted of 54 ESBL-negative and 26 ESBL-positive Gram-negative bacteremia. Multivariate analysis suggested ESBL-positive bacteremia to be associated with long-term central venous catheter (CVC) (odds ratio (OR), 8.7; 95% confidence interval (CI), 1.6-48.1; P=0.01], index culture obtained 48 h post-admission (OR, 3.6; 95% CI, 1-12.3; P=0.04), and exposure to previous antimicrobial therapy (OR, 12.6; 95% CI, 2.1-74; P<0.01). There were no significant differences between groups with regard to length of stay, ICU admission, or mortality rates. Mortality was associated with high Pitt bacteremia score but not inappropriate empirical therapy. Previous antimicrobial therapy, long-term CVC, and hospital-acquired bacteremia were associated with ESBL bacteremia. Neutropenic patients with ESBL bacteremia have increased morality due to other factors than ESBL status. These findings should be validated in other centers and with larger populations.
10.1016/j.ijantimicag.2018.12.003
Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia.
Freire M P,de Oliveira Garcia D,Garcia C P,Campagnari Bueno M F,Camargo C H,Kono Magri A S G,Francisco G R,Reghini R,Vieira M F,Ibrahim K Y,Rossi F,Hajjar L,Levin A S,Hoff P M,Pierrotti L C,Abdala E
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
10.1016/j.cmi.2015.12.010
Is current initial empirical antibiotherapy appropriate to treat bloodstream infections in short-duration chemo-induced febrile neutropenia?
Joncour A,Puyade M,Michaud A,Tourani J-M,Cazenave-Roblot F,Rammaert Blandine
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
INTRODUCTION:Fever of unknown origin is by far the most common diagnosis in low-risk febrile neutropenic patients undergoing chemotherapy. The current empirical regimen combines amoxicillin-clavulanic acid and fluoroquinolones in low-risk neutropenic patients. The aim of this study was to assess the appropriateness of antibiotherapy and the outcome of bloodstream infections (BSI) in patients with expected neutropenia of short duration. METHODS:This 2-year monocentric retrospective study included all consecutive neutropenic febrile adult patients with expected duration of neutropenia ≤ 7 days. They were classified into low- and high-risk groups for complications using the MASCC index. Appropriateness of initial empirical antibiotic regimen was assessed for each BSI. Multivariate analysis was performed to identify factors associated with mortality. RESULTS:Over the study period, 189 febrile episodes with positive blood cultures in neutropenic patients were reported, of which 44 occurred during expected duration of neutropenia ≤ 7 days. Patients were classified as high-risk (n = 27) and low-risk (n = 17). Gram-negative bacteria BSI represented 57% of cases, including only two multidrug-resistant bacteria in high-risk patients. Initial empirical antibiotherapy was appropriate in 86% of cases, and inappropriate in the event of coagulase-negative Staphylococcus BSI (14%), although the outcome was always favorable. In low-risk patients, no deaths and only 12% of severe complications were reported, contrasting with mortality and complication rates of 48% (p < 0.001) and 63% in high-risk patients (p < 0.001), respectively. CONCLUSIONS:Outcome of BSI is favorable in low-risk febrile neutropenic patients, even with inappropriate empirical initial antibiotic regimen for coagulase-negative Staphylococcus BSI. Initial in-hospital assessment and close monitoring of these patients are however mandatory.
10.1007/s00520-019-05113-4
Impact of fluoroquinolone prophylaxis during neutropenia on bloodstream infection: Data from a surveillance program in 8755 patients receiving high-dose chemotherapy for haematologic malignancies between 2009 and 2014.
Kern Winfried V,Weber Susanne,Dettenkofer Markus,Kaier Klaus,Bertz Hartmut,Behnke Michael,Weisser Maja,Götting Tim,Widmer Andreas F,Theilacker Christian,
The Journal of infection
OBJECTIVES:Antibacterial chemoprophylaxis with fluoroquinolones (FQPx) has been commonly used in cancer patients with neutropenia, but its efficacy has been challenged by the emergence of fluoroquinolone resistance. METHODS:The impact of FQPx on bloodstream infections (BSI) during neutropenia after high-dose chemotherapy for haematologic malignancies was evaluated through a multicenter hospital infection surveillance system for the period 2009-2014. RESULTS:Among 8755 patients (4223 allogeneic [allo-] HSCT, 3602 autologous [auto-] HSCT, 930 high-dose chemotherapy for acute leukemia [HDC]), 5302 (61%) had received FQPx. Administration of FQPx was associated with fewer Gram-negative BSI in the overall study cohort patients (4.6% vs. 7.7%, adjusted subdistribution hazard ratio [aSHR] 0.59, 95%CI 0.50-0.70), in patients with HDC (3.7% vs. 9.2%, adjusted subdistribution hazard ratio [aSHR] 0.40, 95%CI 0.22-0.70) and auto-HSCT patients (4% vs. 9%, aSHR 0.43, 95%CI 0.33-0.56). In HDC patients, FQPx was associated with a marked reduction in all-cause mortality during neutropenia (2.3% vs. 7.8%, aSHR 0.30, 95%CI 0.15-0.58). Patients receiving FQPx had significantly more BSIs due to ESBL-positive Enterobacteriacea (0.8 vs. 0.3%, RR 2.2, 95%CI 1.17-4.26). BSIs by MRSA (n = 5) and VRE (n = 11) were rare in our cohort. CONCLUSIONS:As used in the participating centers, FQPx was associated with reduced Gram-negative BSI and improved survival among HDC patients. Among HSCT patients, the benefits were less clear. If adapted to local resistance patterns and patient characteristics, FQPx still may be useful in the management of patients with haematologic malignancies.
10.1016/j.jinf.2018.05.004
Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR).
Gudiol C,Royo-Cebrecos C,Tebe C,Abdala E,Akova M,Álvarez R,Maestro-de la Calle G,Cano A,Cervera C,Clemente W T,Martín-Dávila P,Freifeld A,Gómez L,Gottlieb T,Gurguí M,Herrera F,Manzur A,Maschmeyer G,Meije Y,Montejo M,Peghin M,Rodríguez-Baño J,Ruiz-Camps I,Sukiennik T C,Carratalà J,
BMJ open
INTRODUCTION:Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. METHODS AND ANALYSIS:A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. SAMPLE SIZE:The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. ETHICS AND DISSEMINATION:The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group for Infections in Compromised Hosts (ESGICH).
10.1136/bmjopen-2016-013268
Early versus late onset bloodstream infection during neutropenia after high-dose chemotherapy for hematologic malignancy.
Widmer Andreas F,Kern Winfried V,Roth Jan A,Dettenkofer Markus,Goetting Tim,Bertz Hartmut,Theilacker Christian,
Infection
PURPOSE:The length of neutropenia has a significant impact on the incidence of bloodstream infection (BSI) in cancer patients, but limited information is available about the pathogen distribution in late BSI. METHODS:Between 2002 and 2014, BSI episodes in patients with neutropenia receiving chemotherapy for hematologic malignancies were prospectively identified by multicenter, active surveillance in Germany, Switzerland and Austria. The incidence of first BSI episodes, their microbiology and time to BSI onset during the first episode of neutropenia of 15,988 patients are described. RESULTS:The incidence rate of BSI episodes was 14.7, 8.7, and 4.7 per 1000 patient-days in the first, second, and third week of neutropenia, respectively. BSI developed after a median of 5 days of neutropenia (interquartile range [IQR] 3-10 days). The medium duration of neutropenia to BSI onset was 4 days in Escherichia coli (IQR 3-7 days), Klebsiella spp. (2-8 days), and Staphylococcus aureus (3-6 days). In contrast, BSI due to Enterococcus faecium occurred after a median of 9 days (IQR 6-14 days; p < 0.001 vs. other BSI). Late onset of BSI (occurring after the first week of neutropenia) was also observed for Stenotrophomonas maltophilia (12 days, IQR 7-17 days; p < 0.001), and non-albicans Candida spp. (13 days, IQR 8-19 days; p < 0.001). CONCLUSIONS:Over the course of neutropenia, the proportion of difficult to treat pathogens such as E. faecium, S. maltophilia, and Candida spp. increased. Among other factors, prior duration of neutropenia may help to guide empiric antimicrobial treatment in febrile neutropenia.
10.1007/s15010-019-01327-0
Septic shock and chemotherapy-induced cytopenia: effects on microcirculation.
Karvunidis Thomas,Chvojka Jiri,Lysak Daniel,Sykora Roman,Krouzecky Ales,Radej Jaroslav,Novak Ivan,Matejovic Martin
Intensive care medicine
PURPOSE:Neutrophil and platelet activation and their interactions with endothelial cells are considered central features of sepsis-induced microcirculatory alterations. However, no study has evaluated the microvascular pattern of septic shock patients with chemotherapy-induced severe cytopenia. METHODS:Demographic and hemodynamic variables together with sublingual microcirculation recording [orthogonal polarization spectral imaging enhanced by sidestream dark-field technology (OPS-SDF) videomicroscopy] were collected in four groups of subjects: septic shock (SS, N = 9), septic shock in cytopenic patients (NSS, N = 8), cytopenia without infection (NEUTR, N = 7), and healthy controls (CTRL, N = 13). Except for controls, all measurements were repeated after complete resolution of septic shock and/or neutropenia. Video files were processed using appropriate software tool and semiquantitatively evaluated [total vascular density (TVD, mm/mm(2)), perfused vessel density (PVD, mm/mm(2)), proportion of perfused vessels (PPV, %), mean flow index (MFI), and flow heterogeneity index (FHI)]. RESULTS:Compared with controls, there were statistically significant microcirculatory alterations within all tested groups of patients (TVD: SS = 8.8, NSS = 8.8, NEUTR = 9.1 versus CTRL = 12.6, p < 0.001; PVD: SS = 6.3, NSS = 6.1, NEUTR = 6.9 versus CTRL = 12.5, p < 0.001; PPV: SS = 71.6, NSS = 68.9, NEUTR = 73.3 versus CTRL = 98.7, p < 0.001; MFI: SS = 2.1, NSS = 1.9, NEUTR = 2.1 versus CTRL = 3.0, p < 0.05; FHI: SS = 1.0, NSS = 0.9, NEUTR = 0.6 versus CTRL = 0.0, p < 0.001). No significant differences were detected between SS, NSS, and NEUTR groups at baseline. Incomplete restoration of microcirculatory perfusion was observed after septic shock and/or neutropenia resolution with a trend towards better recovery in MFI and FHI variables in NSS as compared with SS patients. CONCLUSIONS:Microvascular derangements in septic shock did not differ between noncytopenic and cytopenic patients. Our data might suggest that profound neutropenia and thrombocytopenia do not render microcirculation more resistant to sepsis-induced microvascular alterations. The role and mechanisms of microvascular alterations associated with chemotherapy-induced cytopenia warrant further investigation.
10.1007/s00134-012-2582-4
Bloodstream infections in neutropenic patients with haematological malignancies.
Carvalho Ana Sofia,Lagana Diana,Catford Jennifer,Shaw David,Bak Narin
Infection, disease & health
BACKGROUND:Patients with haematological malignancies have higher risk of acquiring bloodstream infection (BSI). Neutropenia resulting from cytotoxic chemotherapy is the most common risk factor. Infections can progress rapidly with poor outcomes. Understanding the epidemiology may enable prevention and effective management. We investigated and compared the incidence of BSI amongst patients with haematological malignancies and neutropenia and examined the changing spectrum of organisms, and their antimicrobial profiles. METHODS:BSI data between July 1st 2009 and June 30th 2015 was reviewed. RESULTS:Three hundred and fifty five BSI were identified in 255 neutropenic patients. Acute myeloid leukaemia (AML) accounted for 40%, Non-Hodgkin's lymphoma for 22% and Acute lymphocytic leukaemia (ALL) for 11.8%. A neutrophil count of <500 cells/μL was present in 93.2%. The overall incidence was 5.40 BSI per 1000 Haematology Occupied Bed days (OBD). Viridans streptococci and Enterococcus species were the most predominant Gram-positives. Vancomycin resistant Enterococcus faecium (VRE) emerged as the predominant Enterococcus species during the study period. Escherichia coli was the most predominant Gram-negative and Extended-spectrum beta-lactamases (ESBL) were detected in 7.1% of isolates. Amongst the Enterobacteriaceae and Pseudomonas aeruginosa dual resistance to Piperacillin-tazobactam and Gentamicin was detected in 5.4%. CONCLUSION:Our incidence of BSI was 5.40 per 1000 OBD, however variability in reporting of rates in neutropenic patients with haematological malignancies makes comparison between studies difficult, highlighting the need for rate reporting standardization. The epidemiology of organisms causing BSI has changed over time. There is a trend towards an increasing incidence of VRE and multidrug resistant Gram-negatives.
10.1016/j.idh.2019.08.006