title: Multidrug-resistant bacteria in hematology patients: emerging threats.
abstract: Multidrug-resistant (MDR) bacteria, particularly Gram negatives, such as Enterobacteriaceae resistant to third-generation cephalosporins or carbapenems and MDR Pseudomonas aeruginosa, are increasingly frequent in hematology patients. The prevalence of different resistant species varies significantly between centers. Thus, the knowledge of local epidemiology is mandatory for deciding the most appr-opriate management protocols. In the era of increasing antibiotic resistance, empirical therapy of febrile neutropenia should be individualized. A de-escalation approach is recommended in case of severe clinical presentation in patients who are at high risk for infection with a resistant strain. Targeted therapy of an MDR Gram negative usually calls for a combination treatment, although no large randomized trials exist in this setting. Infection control measures are the cornerstone of limiting the spread of MDR pathogens in hematology units.
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tatarelli
authors.affiliation: Division of Infectious Diseases, Department of Health Sciences (DISSA), University of Genova and IRCCS San Martino Hospital-IST, Largo R Benzi 10, 16132 Genova, Italy.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Mikulska
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D006405:Hematology / Q000706:statistics & numerical data; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial stewardship; combination treatment; de-escalation; febrile neutropenia; infection control; multidrug-resistant bacteria; selective digestive decontamination; β-lactamase inhibitors