title: Longitudinal surveillance of bacteraemia in haematology and oncology patients at a UK cancer centre and the impact of ciprofloxacin use on antimicrobial resistance.
abstract: OBJECTIVE
  To assess and compare the current trends in bacteraemia and antimicrobial resistance and analyse the impact of ciprofloxacin prescribing on Gram-negative bacterial resistance in haematology and oncology patients.
  
  
  METHODS
  Information on bacteraemia episodes, causative pathogens, antimicrobial resistance and consumption was compared between haematology and oncology patients at a UK cancer centre in a 14 year longitudinal surveillance study.
  
  
  RESULTS
  Haematology patients had a 3-fold higher incidence of bacteraemia compared with oncology patients (10.9/1000 versus 3.6/1000 admissions, respectively). Coagulase-negative staphylococci were the most common Gram-positive cause of bacteraemia for both cancer groups, whereas the overall rate of methicillin-resistant Staphylococcus aureus bacteraemia was low (0.16/1000 admissions). Escherichia coli was the most common Gram-negative cause of bacteraemia for both groups, but with a higher incidence in haematology patients (0.92/1000 admissions) compared with oncology patients (0.5/1000 admissions). Pseudomonas spp. formed the second most common Gram-negative infection in haematology patients, with a 4-fold higher bacteraemia incidence compared with oncology patients (0.76 versus 0.16/1000 admissions). Ciprofloxacin resistance of Gram-negative isolates was 22% in haematology and 5% in oncology patients. The rate of ciprofloxacin use measured showed high ciprofloxacin consumption in haematology patients compared with oncology patients (3.6 versus 1.5 defined daily doses/10 admissions, respectively), suggesting that ciprofloxacin may drive resistance.
  
  
  CONCLUSIONS
  Our longitudinal surveillance highlights the continued importance of Gram-negative bacteraemia, in particular that due to Pseudomonas, in the cancer population and raises concerns regarding increasing ciprofloxacin use and resistance.
authors: Department of Microbiology, Norfolk and Norwich University Hospital, Norwich, UK. sschelenz@doctors.org.uk
authors: S
authors: S
authors: Schelenz
authors: D
authors: D
authors: Nwaka
authors: P R
authors: PR
authors: Hunter
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002173:Cancer Care Facilities; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications*; D008137:Longitudinal Studies; D055624:Methicillin-Resistant Staphylococcus aureus; D008991:Monitoring, Physiologic; D009369:Neoplasms / Q000150:complications*; D016134:Organizational Policy; D013290:Streptococcal Infections / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin
keywords: antimicrobial resistance; bloodstream infections; cancer; immunosuppression