TY - JOUR
T1 - Changing microbial epidemiology in hematopoietic stem cell transplant recipients: increasing resistance over a 9-year period
AU - Macesic, Nenad
AU - Morrissey, Orla
AU - Cheng, Allen Cheuk-Seng
AU - Spencer, Andrew
AU - Peleg, Anton Yariv
PY - 2014
Y1 - 2014
N2 - Infections remain important contributors to mortality in
hematopoietic stem cell transplantation (HSCT).
Method.
We studied the evolving epidemiology and trends in
susceptibility of bacterial and
Candida
isolates at an Australian
HSCT center. A total of 528 HSCTs in 508 patients were performed
from April 2001 to May 2010. A total of 605 isolates were eligible for
study inclusion; 318 (53 ) were gram-positive, 268 (44 ) were gram-
negative, and 19 (3 ) were
Candida
species.
Results.
The most common site for isolates was blood (380 isolates,
63 ).
Staphylococcus aureus
was the most common gram-positive
organism (
n
=
107, 34 ), but trends to increasing coagulase-
negative staphylococci (
P
=
0.002) and vancomycin-resistant
Enterococcus
(
P
<0.001) were observed.
Escherichia coli
was the
most common gram-negative isolate (
n
=
74, 28 ). Fluoroquinolone
resistance increased with widespread use of protocol
fluoroquinolone prophylaxis (
P
=
0.001). Carbapenem resistance
was found in 44 of
Pseudomonas
or
Acinetobacter
isolates.
Bloodstream infection with a multidrug-resistant organism (odds
ratio 3.61, 95 confidence interval: 1.40
?
9.32,
P
=
0.008) was an
independent predictor of mortality at 7 days after a positive blood
culture.
Conclusions.
Antimicrobial resistance is an increasing problem in
this vulnerable patient population, and not only has an impact on
choice of empiric therapy for febrile neutropenia but also on
mortality
AB - Infections remain important contributors to mortality in
hematopoietic stem cell transplantation (HSCT).
Method.
We studied the evolving epidemiology and trends in
susceptibility of bacterial and
Candida
isolates at an Australian
HSCT center. A total of 528 HSCTs in 508 patients were performed
from April 2001 to May 2010. A total of 605 isolates were eligible for
study inclusion; 318 (53 ) were gram-positive, 268 (44 ) were gram-
negative, and 19 (3 ) were
Candida
species.
Results.
The most common site for isolates was blood (380 isolates,
63 ).
Staphylococcus aureus
was the most common gram-positive
organism (
n
=
107, 34 ), but trends to increasing coagulase-
negative staphylococci (
P
=
0.002) and vancomycin-resistant
Enterococcus
(
P
<0.001) were observed.
Escherichia coli
was the
most common gram-negative isolate (
n
=
74, 28 ). Fluoroquinolone
resistance increased with widespread use of protocol
fluoroquinolone prophylaxis (
P
=
0.001). Carbapenem resistance
was found in 44 of
Pseudomonas
or
Acinetobacter
isolates.
Bloodstream infection with a multidrug-resistant organism (odds
ratio 3.61, 95 confidence interval: 1.40
?
9.32,
P
=
0.008) was an
independent predictor of mortality at 7 days after a positive blood
culture.
Conclusions.
Antimicrobial resistance is an increasing problem in
this vulnerable patient population, and not only has an impact on
choice of empiric therapy for febrile neutropenia but also on
mortality
UR - http://onlinelibrary.wiley.com/doi/10.1111/tid.12298/pdf
U2 - 10.1111/tid.12298
DO - 10.1111/tid.12298
M3 - Article
VL - 16
SP - 887
EP - 896
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
SN - 1398-2273
IS - 6
ER -