Abstract：
To describe current resistance to the β-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB).
Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated.
Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three β-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT.
Current resistance to empirical β-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.
Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated.
Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three β-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT.
Current resistance to empirical β-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection.
摘要：
描述当前对由革兰氏阴性杆菌（GNB）引起的血流感染（BSI）发作指南中经验性建议的β-内酰胺的耐药性。
回顾,西班牙14所大学医院血液患者最近50次BSI发作的多中心队列研究。评估了不适当经验性抗生素治疗（IEAT）的发生率和对死亡率的影响。
在700个BSI事件中,308（44%）是由GNB引起的，主要是大肠杆菌（141；20.1％），克雷伯菌属。（56；8%）和铜绿假单胞菌（48；6.9%）。在GNBBSI发作中，80例(26%)由MDR分离株引起。由肠杆菌引起的，25.8%是ESBL生产者，3.5%是碳青霉烯酶生产者。在铜绿假单胞菌BSI发作中，18.8%由MDR分离株引起。总的来说,34.7％的分离GNB对发热性中性粒细胞减少症指南中推荐的三种β-内酰胺中的至少一种（头孢吡肟，哌拉西林/他唑巴坦和美罗培南）。尽管广泛遵守指南建议（91.6％），16.6%的由GNB引起的BSI发作接受了IEAT，在MDRGNB分离株中更常见（46.3％对6.1％；P<0.001）。30天死亡率为14.6%，在接受IEAT的患者中达到21.6%。
对发热性中性粒细胞减少症指南中推荐的经验性β-内酰胺的电流抗性非常高，IEAT率高于预期。迫切需要使指南适应当前的流行病学，并更好地识别发生MDRGNB感染的高风险患者。
回顾,西班牙14所大学医院血液患者最近50次BSI发作的多中心队列研究。评估了不适当经验性抗生素治疗（IEAT）的发生率和对死亡率的影响。
在700个BSI事件中,308（44%）是由GNB引起的，主要是大肠杆菌（141；20.1％），克雷伯菌属。（56；8%）和铜绿假单胞菌（48；6.9%）。在GNBBSI发作中，80例(26%)由MDR分离株引起。由肠杆菌引起的，25.8%是ESBL生产者，3.5%是碳青霉烯酶生产者。在铜绿假单胞菌BSI发作中，18.8%由MDR分离株引起。总的来说,34.7％的分离GNB对发热性中性粒细胞减少症指南中推荐的三种β-内酰胺中的至少一种（头孢吡肟，哌拉西林/他唑巴坦和美罗培南）。尽管广泛遵守指南建议（91.6％），16.6%的由GNB引起的BSI发作接受了IEAT，在MDRGNB分离株中更常见（46.3％对6.1％；P<0.001）。30天死亡率为14.6%，在接受IEAT的患者中达到21.6%。
对发热性中性粒细胞减少症指南中推荐的经验性β-内酰胺的电流抗性非常高，IEAT率高于预期。迫切需要使指南适应当前的流行病学，并更好地识别发生MDRGNB感染的高风险患者。
