Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia.
Future Microbiol
; 10(3): 357-64, 2015.
Article
en En
| MEDLINE
| ID: mdl-25812459
ABSTRACT
BACKGROUND:
Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy.AIM:
To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. MATERIALS &METHODS:
The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each ß-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard).RESULTS:
A total of 263 strains were evaluated 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to ß-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to ß-lactams indicated for monotherapy, and also increase in the resistance to combined therapies.CONCLUSION:
in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Bacteriemia
/
Neutropenia Febril
/
Bacterias Gramnegativas
/
Antibacterianos
/
Neoplasias
Tipo de estudio:
Guideline
/
Observational_studies
/
Qualitative_research
/
Risk_factors_studies
Límite:
Adolescent
/
Child
/
Child, preschool
/
Humans
/
Infant
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
Future Microbiol
Asunto de la revista:
MICROBIOLOGIA
Año:
2015
Tipo del documento:
Article
País de afiliación:
Italia