铜绿假单胞菌的最佳覆盖在发热性中性粒细胞减少症患者中是具有挑战性的,这是由于全球抗生素耐药性的逐渐增加。我们的目的是详细介绍血液系统恶性肿瘤患者对从血流感染(BSI)中分离出的铜绿假单胞菌的国际指南推荐的抗生素的当前耐药率。其次,我们旨在描述有多少患者接受了不适当的经验性抗生素治疗(IEAT)及其对死亡率的影响.我们做了一个回顾,西班牙14所大学医院血液系统恶性肿瘤患者最近20例由铜绿假单胞菌引起的BSI发作的多中心队列研究。在280例由铜绿假单胞菌引起的恶性血液病和BSI患者中,101(36%)的菌株对国际指南中推荐的至少一种β-内酰胺抗生素具有抗性,即,头孢吡肟,哌拉西林他唑巴坦,还有美罗培南.此外,21.1%和11.4%的菌株符合铜绿假单胞菌MDR和XDR标准,分别。即使在大多数情况下遵循国际准则,47例(16.8%)患者接受IEAT治疗,66例(23.6%)患者接受不适当的β-内酰胺经验性抗生素治疗。30天死亡率为27.1%。在多变量分析中,肺源(OR2.22,95%CI1.14~4.34)和IEAT(OR2.67,95%CI1.37~5.23)是与死亡率增加独立相关的因素.我们得出的结论是,恶性血液病患者中铜绿假单胞菌引起的BSI通常对国际指南中推荐的抗生素具有耐药性。这与频繁的IEAT和较高的死亡率有关。需要新的治疗策略。重要性铜绿假单胞菌引起的血流感染(BSI)与中性粒细胞减少患者的发病率和死亡率升高相关。出于这个原因,最佳的抗伪粒子覆盖是经验治疗发热性中性粒细胞减少症的所有历史建议的基础.然而,近年来,多种抗生素耐药性的出现对治疗这种微生物引起的感染提出了挑战。在我们的研究中,我们假设恶性血液病患者中铜绿假单胞菌引起的BSI通常对国际指南中推荐的抗生素具有耐药性。这一观察结果与频繁的IEAT和死亡率增加有关。因此,需要一种新的治疗策略.
Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international
guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the β-lactam antibiotics recommended in international
guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international
guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate β-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international
guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed. IMPORTANCE Bloodstream infection (BSI) caused by P. aeruginosa is related with an elevated morbidity and mortality in neutropenic patients. For this reason, optimal antipseudomonal coverage has been the basis of all historical recommendations in the empirical treatment of febrile neutropenia. However, in recent years the emergence of multiple types of antibiotic resistances has posed a challenge in treating infections caused by this microorganism. In our study we postulated that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international
guidelines. This observation is associated with frequent IEAT and increased mortality. Consequently, there is a need for a new therapeutic strategy.