Bacterial resistance in hematology wards was found to be related to
health care and influenced by previous antibiotic use and length of stay in
febrile neutropenic patients, according to research presented at the 2011
Interscience Conference on Antimicrobial Agents and Chemotherapy.
Researchers assessed risk factors for cefepime resistance (CFP-R) at the
onset of fever in a
hematology ward from January 2008 to June 2010. They
established a scoring system to predict CFP-R at bedside to indicate when
additional antibiotics could be useful until bacterial documentation.
Using recommendations from the Comite de l'Antibiogramme de la
Société Française de Microbiologie or results from natural
resistance, susceptibility testing determined the CFP-R of isolates, according
to the study. Researchers used multivariate logistic regression with backward
selection for selecting risk factors for CFP-R. CFP-R with internal validation
was predicted by a scoring system using the bootstrap resampling technique.
Researchers found an overall rate of 49% (95% CI, 39-59) for CFP-R. Of
155 episodes of bacteremia, 66% of first episodes included 21
Enterobacteriaceae, four Pseudomonas aeruginosa, 35 staphylococci and 25
streptococci. Acute lymphoblastic leukemia (OR=6; P,.04), 18 or more days since
hospital admission (OR=4.7; P,.005), and receipt of any beta-lactam in the past
month (OR=3.6; P,.04) were risk factors associated with CFP-R, but
neutropenia and severe sepsis were not associated with CFP-R.
There was an 81% (95% CI, 25-100) chance that febrile hematology patients were
carrying a CFP-R if they had two or three of the risk factors.
For more information:
- Maaroufi HE. #1123. Presented at: 2011 Interscience Conference on
Antimicrobial Agents and Chemotherapy; Sept. 17-20; Chicago.
Disclosure: Dr. Maaroufi reports no relevant financial