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INCIDENCE OF BACTEREMIA BY MULTI-RESISTANT BACTERIA IN HEMATOLOGY PATIENTS. A DESCRIPTIVE EPIDEMIOLOGIC STUDY FROM A THIRD LEVEL HOSPITAL.
Author(s):
Agustin Nieto Vazquez
Agustin Nieto Vazquez
Affiliations:
Hematology,SERGAS. Hospital Alvaro Cunqueiro,Vigo,Spain
(Abstract release date: 05/18/17) EHA Library. Nieto Vazquez A. 05/18/17; 182605; PB1891
Agustin Nieto Vazquez
Agustin Nieto Vazquez
Contributions
PDF Abstract
Abstract

Abstract: PB1891

Type: Publication Only

Background
In recent years the incidence of multi-resistant bacteria (MRB) infections have notably increase. These infections are especially serious in hematological patients because of the immunosupression derived from their illness and their treatments. This increase is related to a high mortality rate and high health costs due to the severity of the infections and the difficulty in setting adequate therapy due to the lack of new antibiotics against these pathogens.

Aims
Define the MRB infections incidence and ways of presentation. As a secondary goal we try to determine if the isolation of these MRB has affected our empiric antibiotic therapy decision.

Methods
We retrospectively collected all positive blood stream cultures from hematologic patients from January 2012 to December 2016. We studied the characteristics, clinical features and pathogen isolates of our patients when the blood cultures were obtained.

Results
1005 positive blood stream cultures were collected in 382 patients. The main characteristics of the patients are shown on table 1. The infection source was: central venous catheter (CVC) in 48% of patients (including tunneled, non-tunneled and PICC lines), respiratory 10%, abdominal 8%, urinary 5%, skin/soft tissue 7% and multiple location 5%. Regarding CVC isolation's, 11% were interpreted as contamination and 6% as colonization.

Gram positive (G+) bacteria were more frequently isolated than Gram negative (G-) (72% vs 24%). Most common G+ bacteria was coagulase negative Staphylococcus, regarding G- E. Coli, Klebsiella sp and Pseudomonas aeruginosa.
MRB were detected in 6.1% of blood cultures being the most frequent G- (85%). The main resistance mechanism was extended-spectrum beta-lactamases (ESBL) and carbapenemases (CP) production (table 2). BMR infections increased significantly in last year, mainly associated to CP, 0.5% in 2012 up to 7.1% in 2016 (graphic 1). 29.5% of MRB infections developed in patients identified as chronic carriers of multiresistant organisms and 100% of them had extensive exposure to wide spectrum antimicrobials previously.
14% of infections began with a serious illness (persistent hyperthermia, hemodynamic disbalance and worsening), 5% needed intensive care assistance and 15% died because of the infection. In MRB infections, 44% were severe, 6% needed ICU and 25% died.
The most common empirical antibiotic therapy was carbapenems - 12% in monotherapy, 17% with glucopeptids - followed by third generation cephalosporins in 7%. Related to febrile episodes in MRB known carriers: empiric treatment includes effective antibiotic against this MRB (including colistin and carbapenems in extended infusion) was started in 15% of patients, all with serious illness at diagnosis.

Conclusion
- Current antimicrobial resistance, especially concerning G- in our study, is particularly worrisome due to development of resistance to all available antimicrobial agents. The incidence of multi-resistant G+ is not very high.

- Clinical presentation in MBR infections is more serious in our experience, and the mortality doubles in relation to the difficulty to establish appropriate treatment.
- Severity sings at infection diagnosis in MRB carriers had led us to a change of empirical antibiotic therapy.
- As reported in previous literature, prevention of transmission, a quick establishment of diagnosis and an effective treatment, along with a correct and limited use of antibiotic therapy could decrease the development of MRB.

Session topic: 29. Infectious diseases, supportive care

Abstract: PB1891

Type: Publication Only

Background
In recent years the incidence of multi-resistant bacteria (MRB) infections have notably increase. These infections are especially serious in hematological patients because of the immunosupression derived from their illness and their treatments. This increase is related to a high mortality rate and high health costs due to the severity of the infections and the difficulty in setting adequate therapy due to the lack of new antibiotics against these pathogens.

Aims
Define the MRB infections incidence and ways of presentation. As a secondary goal we try to determine if the isolation of these MRB has affected our empiric antibiotic therapy decision.

Methods
We retrospectively collected all positive blood stream cultures from hematologic patients from January 2012 to December 2016. We studied the characteristics, clinical features and pathogen isolates of our patients when the blood cultures were obtained.

Results
1005 positive blood stream cultures were collected in 382 patients. The main characteristics of the patients are shown on table 1. The infection source was: central venous catheter (CVC) in 48% of patients (including tunneled, non-tunneled and PICC lines), respiratory 10%, abdominal 8%, urinary 5%, skin/soft tissue 7% and multiple location 5%. Regarding CVC isolation's, 11% were interpreted as contamination and 6% as colonization.

Gram positive (G+) bacteria were more frequently isolated than Gram negative (G-) (72% vs 24%). Most common G+ bacteria was coagulase negative Staphylococcus, regarding G- E. Coli, Klebsiella sp and Pseudomonas aeruginosa.
MRB were detected in 6.1% of blood cultures being the most frequent G- (85%). The main resistance mechanism was extended-spectrum beta-lactamases (ESBL) and carbapenemases (CP) production (table 2). BMR infections increased significantly in last year, mainly associated to CP, 0.5% in 2012 up to 7.1% in 2016 (graphic 1). 29.5% of MRB infections developed in patients identified as chronic carriers of multiresistant organisms and 100% of them had extensive exposure to wide spectrum antimicrobials previously.
14% of infections began with a serious illness (persistent hyperthermia, hemodynamic disbalance and worsening), 5% needed intensive care assistance and 15% died because of the infection. In MRB infections, 44% were severe, 6% needed ICU and 25% died.
The most common empirical antibiotic therapy was carbapenems - 12% in monotherapy, 17% with glucopeptids - followed by third generation cephalosporins in 7%. Related to febrile episodes in MRB known carriers: empiric treatment includes effective antibiotic against this MRB (including colistin and carbapenems in extended infusion) was started in 15% of patients, all with serious illness at diagnosis.

Conclusion
- Current antimicrobial resistance, especially concerning G- in our study, is particularly worrisome due to development of resistance to all available antimicrobial agents. The incidence of multi-resistant G+ is not very high.

- Clinical presentation in MBR infections is more serious in our experience, and the mortality doubles in relation to the difficulty to establish appropriate treatment.
- Severity sings at infection diagnosis in MRB carriers had led us to a change of empirical antibiotic therapy.
- As reported in previous literature, prevention of transmission, a quick establishment of diagnosis and an effective treatment, along with a correct and limited use of antibiotic therapy could decrease the development of MRB.

Session topic: 29. Infectious diseases, supportive care

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