title: Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey.
abstract: A prospective cohort study was conducted in nine hematology wards at tertiary care centres or at university hospitals located throughout Italy from January 2009 to December 2012. All of the cases of bacterial bloodstream infection (BBSI) occurring in adult patients with hematologic malignancies were included. A total of 668 bacterial isolates were recovered in 575 BBSI episodes. Overall, the susceptibility rates of Gram-negative bacteria were 59.1% to ceftazidime, 20.1% to ciprofloxacin, 79.1% to meropenem, 85.2% to amikacin, 69.2% to gentamicin and 69.8% to piperacillin/tazobactam. Resistance to third-generation cephalosporins was found in 98/265 (36.9%) of Enterobacteriaceae isolates. Among Klebsiella pneumoniae strains, 15/43 (34.9%) were resistant to carbapenems. Of 66 Pseudomonas aeruginosa isolates, 46 (69.7%) were multidrug resistant. Overall, the susceptibility rates of Gram-positive bacteria were 97.4% to vancomycin and 94.2% to teicoplanin. Among the monomicrobial cases of BBSI, the 21-day mortality rate was significantly higher for those caused by Gram-negative bacteria compared to those caused by Gram-positive bacteria (47/278, 16.9% vs. 12/212, 5.6%; p < 0.001). Among Gram-negative bacteria, the mortality rate was significantly higher for BBSI caused by K. pneumoniae, P. aeruginosa, and Acinetobacter baumannii. Our results confirm the recently reported shift of prevalence from Gram-positive to Gram-negative bacteria as causative agents of BBSIs among patients with hematologic malignancies and highlight a worrisome increasing frequency in antimicrobial resistance among Gram-negative bacteria.
authors.affiliation: Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: enricomaria.trecarichi@rm.unicatt.it.
authors.forename: E M
authors.initials: EM
authors.lastname: Trecarichi
authors.affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pagano
authors.affiliation: Clinica di Ematologia, Università di Udine, Udine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Candoni
authors.affiliation: Ematologia con Trapianto Azienda Ospedaliero Universitaria Policlinico, Bari, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pastore
authors.affiliation: U. O. Ematologia, Spedali Civili, Brescia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cattaneo
authors.affiliation: Unità Operativa di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fanci
authors.affiliation: Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nosari
authors.affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Caira
authors.affiliation: Ematologia, Istituto Regina Elena, Roma, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spadea
authors.affiliation: Divisione di Ematologia, Ospedale le Molinette, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Busca
authors.affiliation: Istituto di Ematologia ed Oncologia Clinica "Lorenzo e Ariosto Serágnoli," Ospedale, S. Orsola-Malpighi, Università di Bologna, Bologna, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Vianelli
authors.affiliation: Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062606:Tertiary Care Centers
keywords: Antimicrobial resistance; bacterial bloodstream infections; epidemiology; hematologic cancer; mortality; multidrug resistance