title: Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel).
abstract: Multiresistant bacterial infections are a potentially life-threatening condition in acute leukaemia (AL) patients. We aimed to better define the very recent epidemiology and outcome of bloodstream infections (BSIs) in a real-life setting. We prospectively collected all consecutive febrile/infectious episodes occurring in AL patients admitted to 9 haematology units. In 293 AL patients, 433 BSIs were diagnosed. Gram-positive (GP) bacteria were isolated in 44.8 % BSI and Gram-negative (GN) in 38.3 %, while polymicrobial aetiology- or fungi-related events were identified in 15.7 and 1.1 % of the cases, respectively. GP was observed more frequently in patients not in complete remission (p = 0.04), while GN during consolidation cycles (p = 0.003). Extended spectrum β-lactamase-producing strains accounted for 23.2 % of enterobacteria. They were associated with previous antibiotic exposure, including fluoroquinolones prophylaxis (p = 0.01). Carbapenem-resistant (CR) strains occurred in 9 % of enterobacteria. Among Pseudomonas aeruginosa strains, 21.6 % were multiresistant. Overall 30-day mortality was 8.5 %. CR GN and multiresistant P. aeruginosa BSIs were independent predictors of death (p = 0.002), as well as relapsed/resistant AL (18.3 %; p = 0.0002) and the presence of pulmonary infiltrates (26.6 %; p < 0.001). Although GP still predominate over GN BSI, the percentage of antibiotic resistant GN strains is considerable in AL patients and it is associated with poor prognosis.
authors.affiliation: Department of Hematology, Spedali Civili, 25123, Brescia, Italy. chiara.cattaneo@libero.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zappasodi
authors.affiliation: Dipartimento di Oncologia e Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Mancini
authors.affiliation: U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milano, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Annaloro
authors.affiliation: San Raffaele Scientific Institute of Milan, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pavesi
authors.affiliation: Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Skert
authors.affiliation: Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferrario
authors.affiliation: Humanitas Cancer Center, Humanitas Clinical and Research Cancer Center, Rozzano, Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Todisco
authors.affiliation: Department of Internal Medicine, Division of Hematology, Ospedale Valduce, Como, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Saccà
authors.affiliation: San Gerardo Hospital, Monza, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Verga
authors.affiliation: Department of Hematology, Spedali Civili, 25123, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Passi
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Da Vià
authors.affiliation: Dipartimento di Oncologia e Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: U.O. Oncoematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mometto
authors.affiliation: Department of Hematology, Spedali Civili, 25123, Brescia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Petullà
authors.affiliation: Dipartimento di Oncologia e Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nosari
authors.affiliation: Department of Hematology, Spedali Civili, 25123, Brescia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000502:physiology; D019008:Drug Resistance, Neoplasm / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute leukaemia; Bloodstream infections; Fluoroquinolone prophylaxis; Multiresistant bacteria