Risk factors for and clinical outcomes of carbapenem non-susceptible gram negative bacilli bacteremia in patients with acute myelogenous leukemia

BMC Infectious Diseases

Pyoeng Gyun Choe¹  Dong Hoon Shin¹  Sung-soo Yoon¹  Chang Kyung Kang¹  Suhyeon Park¹  Youngil Koh¹  Wan Beom Park¹  Nam-Joong Kim¹  Myoung-don Oh¹  Jieun Park¹  Kang Il Jun¹  Dong-Yeop Shin¹  Jun Shik Hong¹  Inho Kim¹  Taek Soo Kim² 

[1] Department of Internal Medicine, Seoul National University College of Medicine;Department of Laboratory Medicine, Seoul National University College of Medicine;

关键词: Carbapenem non-susceptible;    Gram negative bacilli;    Bacteremia;    Acute myelogenous leukemia;    Risk factors;   

DOI  :  10.1186/s12879-020-05131-2

来源: DOAJ

【 摘 要 】

Abstract Background Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. Methods We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital. Results Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3–284.1; P < 0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4–112.5; P = 0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1–1.2; P < 0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0–14.8; P < 0.001). Conslusion Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.

【 授权许可】

Unknown