title: Cefepime-resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies.
abstract: OBJECTIVE
  This study was performed to determine the local etiologic pattern of blood culture isolates and antibiotic resistance in febrile neutropenic patients with hematological malignancies.
  
  
  METHODS
  A total of 142 blood culture isolates from febrile neutropenic patients admitted to our hematology unit were examined, particularly for the detection of cefepime resistance, because cefepime, a fourth-generation cephalosporin, has been used in our unit as initial therapy for febrile neutropenia.
  
  
  RESULTS
  Among all isolates, 67 (47.2%) were Gram-positive bacteria, the majority of which were fully sensitive to vancomycin. Gram-negative bacteria accounted for 68 (47.9%) of the isolates. Cefepime resistance was seen in 24 (35.3%) of the Gram-negative isolates, and had significantly increased in 2007. The cefepime-resistant isolates primarily consisted of Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Approximately 60% of the cefepime-resistant isolates were extended-spectrum β-lactamase (ESBL)-producing organisms. Molecular analysis showed the predominant emergence of CTX-M types. Most of the cefepime-resistant isolates were resistant to third- and various fourth-generation cephalosporins, while having a high susceptibility to carbapenems, particularly meropenem.
  
  
  CONCLUSIONS
  Cefepime resistance was often detected in the blood culture isolates from febrile neutropenic patients. This result suggests that therapeutic strategies for febrile neutropenia should be modified based on the local antibiotic resistance patterns.
authors.affiliation: Department of Blood and Marrow Transplantation, Hara-Sanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, Japan. ychong@gj9.so-net.ne.jp
authors.forename: Yong
authors.initials: Y
authors.lastname: Chong
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yakushiji
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ito
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kamimura
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D000077723:Cefepime; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000209:etiology; D005334:Fever / Q000209:etiology; D005798:Genes, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D009503:Neutropenia / Q000150:complications*; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; D001618:beta-Lactamases