title: Risk factors and scoring system for predicting bacterial resistance to cefepime as used empirically in haematology wards.
abstract: OBJECTIVE
  Bacterial resistance is of growing concern in haematology wards. As the inappropriate administration of empirical antibacterial may alter survival, we studied risk factors for resistance to our usual empirical first-line antibacterial therapy, cefepime.
  
  
  METHODS
  We retrospectively studied 103 first episodes of bacteraemia recorded in our haematology department over 2.5 years. Risk factors for cefepime-resistance were identified by multivariate logistic regression with backward selection (P < 0.05). A scoring system for predicting cefepime-resistance was built on independent factor, with an internal validation by the bootstrap resampling technique.
  
  
  RESULTS
  38 (37%) episodes were due to Gram-negative bacteria. Fifty (49%) were due to bacteria resistant to cefepime. Cefepime resistance was significantly associated with a decreased survival at day 30 (P < 0.05). Three risk factors were independently associated with cefepime-resistance: acute lymphoblastic leukaemia; ≥18 days since hospital admission; and receipt of any β-lactam in the last month. Patients with ≥2 of these risk factors had a probability of 86% (CI 95%, 25 to 100%) to carry a cefepime-resistant strain.
  
  
  CONCLUSIONS
  Using our scoring system should reduce the indication of very broad antibacterial regimens in the empirical, first-line treatment of febrile hematology patients in more than 80% of the cases.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France ; Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco.
authors.forename: Hicham
authors.initials: H
authors.lastname: El Maaroufi
authors.affiliation: Microbiology Laboratory, Henri Mondor Hospital, 94000 Créteil, France.
authors.forename: Agathe
authors.initials: A
authors.lastname: Goubard
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France.
authors.forename: Rabah
authors.initials: R
authors.lastname: Redjoul
authors.affiliation: Microbiology Laboratory, Henri Mondor Hospital, 94000 Créteil, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Legrand
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Pautas
authors.affiliation: Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mikdame
authors.affiliation: Haematology Department, Hôpital Militaire d'Instruction Mohamed V, Rabat, Morocco.
authors.forename: Kamal
authors.initials: K
authors.lastname: Doghmi
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France.
authors.forename: Andréa
authors.initials: A
authors.lastname: Toma
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maury
authors.affiliation: Equipe ATIP/AVENIR, INSERM, UMR 738, 75018 Paris, France ; University Paris Diderot, Sorbonne Paris Cité, UMR 738, 75018 Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwarzinger
authors.affiliation: Assistance Publique-Hôpitaux de Paris (APHP), Haematology Department, Henri Mondor Hospital and Paris-Est-Créteil University, 94000 Créteil, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D006090:Gram-Negative Bacteria; D006748:Hospital Departments; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged
chemical_list: D002511:Cephalosporins; D000077723:Cefepime