title: Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011).
abstract: The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.
authors: adiana@hadassah.org.il dina8282@walla.co.il
authors: Diana
authors: D
authors: Averbuch
authors: Catherine
authors: C
authors: Cordonnier
authors: David M
authors: DM
authors: Livermore
authors: Malgorzata
authors: M
authors: Mikulska
authors: Christina
authors: C
authors: Orasch
authors: Claudio
authors: C
authors: Viscoli
authors: Inge C
authors: IC
authors: Gyssens
authors: Winfried V
authors: WV
authors: Kern
authors: Galina
authors: G
authors: Klyasova
authors: Oscar
authors: O
authors: Marchetti
authors: engelhard@hadassah.org.il
authors: Dan
authors: D
authors: Engelhard
authors: Murat
authors: M
authors: Akova
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects* / Q000502:physiology; D005060:Europe / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017410:Practice Guidelines as Topic / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents