title: Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia.
abstract: BACKGROUND
  Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy.
  
  
  OBJECTIVE
  To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication.
  
  
  METHODS
  The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard).
  
  
  RESULTS
  A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies.
  
  
  CONCLUSIONS
  in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.
authors: Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors: Elio
authors: E
authors: Castagnola
authors: Ilaria
authors: I
authors: Caviglia
authors: Luisa
authors: L
authors: Pescetto
authors: Francesca
authors: F
authors: Bagnasco
authors: Riccardo
authors: R
authors: Haupt
authors: Roberto
authors: R
authors: Bandettini
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D064147:Febrile Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000150:complications / Q000382:microbiology*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative; Piperacillin-tazobactam; amikacin; bacteremia; ceftazidime; empirical therapy; febrile neutropenia; meropenem; resistance