title: Clinical Features and Risk Factors for Development of Breakthrough Gram-Negative Bacteremia during Carbapenem Therapy.
abstract: With the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB were Stenotrophomonas maltophilia (n = 33), Acinetobacter baumannii (n = 32), Pseudomonas aeruginosa (n = 21), and others (n = 15). Approximately 90% of S. maltophilia isolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest that S. maltophilia, A. baumannii, and P. aeruginosa are the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Ji-Yong
authors: JY
authors: Lee
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea collacin@hotmail.com.
authors: Cheol-In
authors: CI
authors: Kang
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jae-Hoon
authors: JH
authors: Ko
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Woo Joo
authors: WJ
authors: Lee
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Hye-Ri
authors: HR
authors: Seok
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Ga Eun
authors: GE
authors: Park
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Sun Young
authors: SY
authors: Cho
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Young Eun
authors: YE
authors: Ha
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Doo Ryeon
authors: DR
authors: Chung
authors: Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Nam Yong
authors: NY
authors: Lee
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Kyong Ran
authors: KR
authors: Peck
authors: Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jae-Hoon
authors: JH
authors: Song
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D012307:Risk Factors; D020615:Stenotrophomonas maltophilia / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D016019:Survival Analysis; D062606:Tertiary Care Centers; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D064704:Levofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination