1887

Abstract

One hundred and twenty-three breakthrough bacteraemias (BB) were defined during a 5-year period in a National Cancer Centre, among 9986 admissions and a total of 979 bacteraemic episodes analysed. Of 123 bacteraemias in 103 patients, 77 were polymicrobial and 116 of the 323 organisms isolated were resistant to currently administered antimicrobial agents. Sixty-seven of the bacteraemic episodes were catheter-associated, as confirmed by the isolation of the same organisms from both blood and catheter tip. The strains isolated most frequently were coagulase-negative staphylococci (30.5%), corynebacteria (10%), (9%) and viridans streptococci (8.5%). Gram-positive aerobes accounted for two-thirds of all micro-organisms isolated during breakthrough bacteraemic and fungaemic episodes. Polymicrobial episodes were associated more frequently with vascular catheters and neutropenia, and had a less favourable outcome than monomicrobial infections. Relapse was associated more frequently with catheter-related episodes, but the overall mortality rate was similar and independent of catheter insertion. Breakthrough bacteraemic and fungaemic episodes were associated more frequently with acute leukaemia. Catheter removal, as an independent variable, and modification of antimicrobial therapy were essential for better outcome.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/00222615-46-6-517
1997-06-01
2024-04-27
Loading full text...

Full text loading...

/deliver/fulltext/jmm/46/6/medmicro-46-6-517.html?itemId=/content/journal/jmm/10.1099/00222615-46-6-517&mimeType=html&fmt=ahah

References

  1. EORTC Antimicrobial Therapy Group Prospective comparison of three antibiotic regimens for empirical therapy of suspected infection in febrile granulocytopenia patients. Infect Dis 1978; 137:22–29
    [Google Scholar]
  2. EORTC International Antimicrobial Therapy Cooperative Group Ceftazidime combined with a short or long course of amikacin for empirical therapy of gram-negative bacteremia in cancer patients with granulocytopenia. N Engl J Med 1987; 317:1692–1698
    [Google Scholar]
  3. EORTC International Antimicrobial Therapy Cooperative Group and the National Cancer Institute of Canada -Clinical Trials Group Vancomycin added to empirical combination antibiotic therapy for fever in granulocytopenic cancer patients. J Infect Dis 1991; 163:951–958
    [Google Scholar]
  4. Meunier F., Zinner S. H., Gaya H. EORTC Antimicrobial Therapy Group. Prospective randomized evaluation of ciprofloxacin versus piperacillin plus amikacin for empiric antibiotic therapy of febrile granulocytopenic cancer patients with lymphomas and solid tumors. Antimicrob Agents Chemother 1991; 35:873–878
    [Google Scholar]
  5. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer Efficacy and toxicity of single daily doses of amikacin and cetriaxone versus multiple daily doses of amikacin and ceftazidime for infection in patients with cancer and granulocytopenia. Ann Intern Med 1993; 119:584–593
    [Google Scholar]
  6. EORTC International Antimicrobial Therapy Cooperative Group A prospective double blind study of pefloxacin plus penicillin or placebo for prophylaxis of bacterial infections in granulocytopenic cancer patients. 32nd ICAAC, Anaheim. 1992 Abstract no 1692
  7. Gaya H. International Antimicrobial Therapy Cooperative Group. Piperacillin/tazobactam plus amikacin versus ceftazidime plus amikacin as empirical therapy for fever in patients with granulocytopenia. 33rd ICAAC, New Orleans 1993 Abstract no. 645
  8. International Antimicrobial Therapy Cooperative Group of the EORTC A randomized study on meropenem versus ceftazidim plus amikacin in febrile granulocytopenic patients. Abstracts 34th ICAAC; Orlando: 1994 Abstract no. 1193
    [Google Scholar]
  9. Kern W., Andriof E., Oethinger M., Kern P., Hacker J., Marre R. Emergence of fluoroquinolone-resistant Escherichia coli at a cancer center. Antimicrob Agents Chemother 1994; 38:681–687
    [Google Scholar]
  10. Cometta A., Calandra T., Bille T., Galazzo J., Giddey M., Glauser M. Quinolone resistant Escherichia coli bacteraemias in neutropenic cancer patients. Proceedings of the IHS Symposium, Davos 1994 Abstract no. 84
    [Google Scholar]
  11. Carratala J., Femandez-Swilla A., Tubau F., Callis M., Gudiol F. Emergence of quinolone resistant Escherichia coli bacteremia in neutropenic patients with cancer who have received prophylactic norfloxacin. Clin Infect Dis 1995; 20:557–560
    [Google Scholar]
  12. Noskin G. A., Peterson L. R., Warren J. R. Enterococcus faecium and Enterococcus faecalis bacteraemia: acquisition and outcome. Clin Infect Dis 1995; 20:296–301
    [Google Scholar]
  13. Bochud P., Eggimann P., Calandra T., Van Melle G., Saghafi L., Franciol P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 1994; 18:25
    [Google Scholar]
  14. Krcmery V., Trupl J. Nosocomial outbreak of meropenem resistant Pseudomonas aeruginosa infections in a cancer centre. J Hosp Infect 1994; 26:69–71
    [Google Scholar]
  15. Wingard J. R., Merz W. G., Rinaldi M. G., Johnson T. R., Karp J. E., Sarah R. Increase in Candida krusei infection among patients with hone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991; 325:1274–1277
    [Google Scholar]
  16. Viscoli C. Surveillance of fungaemias in cancer centres. EORTC study Abstracts, 6th BICON Annual Meeting, Bratislava 1995 Abstract no. 33; 19.-23.3
    [Google Scholar]
  17. Chow J., Fine M., Shlaes D. M. Enterobacter bacteraemia: clinical features and emergence of antibiotic resistance during therapy. Ann Infect Med 1991; 115:585–590
    [Google Scholar]
  18. Rosenthal E. J. K. [Epidemiologie von Septikamie-Erregen. Blut-kulturstudie der Paul-Ehrlich-Gesellschaft lur Chemotherapie e. V]. Dtsch Med Wochenschr 1993; 118:1269–1275
    [Google Scholar]
  19. Lecciones J., Lee J., Navarro E. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis 1992; 16:875
    [Google Scholar]
  20. Tilley G., Roberts F. Bacteremia with Acinetobacter species: risk factors and prognosis in different clinical settings. Clin Infect Dis 1994; 18:896–900
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/00222615-46-6-517
Loading
/content/journal/jmm/10.1099/00222615-46-6-517
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error