Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients

ABSTRACT The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 h of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.

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Isolation and Identification of Gram-Negative Bacteria from Oral Cancer Site Infections and Study of Their Antibiotic Resistance Pattern

Bangladesh Journal of Microbiology ◽

10.3329/bjm.v36i2.45533 ◽

2020 ◽

Vol 36 (2) ◽

pp. 85-90

Author(s):

Samiha Ashreen ◽

Akash Ahmed ◽

Nadimul Hasan ◽

Waheed Akhtar ◽

M Mahboob Hossain

Keyword(s):

Oral Cancer ◽

Cancer Patients ◽

Penicillin G ◽

Cancer Site ◽

Control Group ◽

Isolation And Identification ◽

Sensitivity Testing ◽

Vast Number ◽

Gram Negative ◽

Increased Risk

Cancer is one of the non-communicable lethal diseases which affects millions of people worldwide and is responsible for the majority of global deaths. Among the types of cancers occurring in humans, oral cancer has a higher incident rate which is significantly alarming. Oral cancer sites are associated with increased risk of metastasis, along with making the cancer site susceptible to infection by a vast number of opportunistic pathogens. Gram-negative opportunistic bacilli can dwell in these cancer ulcer sites since the patient becomes immune compressed due to radiotherapy and chemotherapy treatments, which prolong the infection. The present study was undertaken to find the most prevalent gram-negative bacilli in oral cavity cancer sites. Swab samples from 50 oral cancer patients were taken to check the presence of the opportunistic organisms. While the control group was set with people with no cancer, only 4 bacteria were isolated from 40 healthy volunteers. Among the isolates from both test group and control group, the most prevalent organism was Klebsiella species 37(45%), followed by Pseudomonas species 29 (34.5%) and Proteus species 8(9.5%). The least prevalent was Escherichia coli 5(6%). The isolates were all taken for antibiotic sensitivity testing (AST) against 15 antibiotics from 11 different groups used in hospitals. Results of the AST were as follows: 100% of the isolates from cancer patients were resistant to vancomycin, clindamycin, amoxicillin, penicillin G, and metronidazole. It was followed by azithromycin, where 86.25% of the isolates were resistant to it. The least resistance was seen against aminoglycoside antibiotic group, amikacin (6.25%), then gentamicin having a resistance percentage of 7.5. A substantial amount of qualitative data on medical history, clinical examination, and treatment, etc. was documented and presented in this study. Bangladesh J Microbiol, Volume 36 Number 2 December 2019, pp 85-90

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Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab260 ◽

2021 ◽

Vol 8 (7) ◽

Author(s):

Mohammod Jobayer Chisti ◽

Jason B Harris ◽

Ryan W Carroll ◽

K M Shahunja ◽

Abu S M S B Shahid ◽

...

Keyword(s):

Mortality Rate ◽

Young Children ◽

High Mortality ◽

Diarrhoeal Disease ◽

Salmonella Typhi ◽

Antibiotic Resistant ◽

Gram Negative ◽

Empiric Antibiotics ◽

Risk Of Death ◽

Gram Negative Bacteremia

Abstract Background Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. Methods We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. Results A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). Conclusions Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed.

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CEFTAZIDIME COMBINED WITH A SHORT OR LONG COURSE OF AMIKACIN FOR EMPIRICAL THERAPY OF GRAM-NEGATIVE BACTEREMIA IN CANCER PATIENTS WITH GRANULOCYTOPENIA

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-198809000-00028 ◽

1988 ◽

Vol 7 (9) ◽

pp. 678

Author(s):

&NA;

Keyword(s):

Cancer Patients ◽

Empirical Therapy ◽

Gram Negative ◽

Gram Negative Bacteremia ◽

Long Course

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Lipopolysaccharide-binding protein: a possible diagnostic marker for Gram-negative bacteremia in neutropenic cancer patients

Intensive Care Medicine ◽

10.1007/s00134-003-2026-2 ◽

2003 ◽

Vol 29 (12) ◽

pp. 2157-2161 ◽

Cited By ~ 30

Author(s):

Claudi S. M. Oude Nijhuis ◽

Edo Vellenga ◽

Simon M. G. J. Daenen ◽

Winette T. A. van der Graaf ◽

Jourik A. Gietema ◽

...

Keyword(s):

Cancer Patients ◽

Diagnostic Marker ◽

Binding Protein ◽

Protein A ◽

Lipopolysaccharide Binding Protein ◽

Gram Negative ◽

Gram Negative Bacteremia ◽

Lipopolysaccharide Binding

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Multidrug-resistant Gram-negative Bacteremia in Cancer Patients: Development of a Clinical Score for Risk Assessment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1906 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S710-S710

Author(s):

Alberto Carena ◽

Ana Laborde ◽

Inés Roccia Rossi ◽

Graciela Guerrini ◽

Rosana Jordán ◽

...

Keyword(s):

Risk Assessment ◽

Cancer Patients ◽

Clinical Score ◽

Multidrug Resistant ◽

Gram Negative ◽

Gram Negative Bacteremia

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Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia

Journal of Infection ◽

10.1016/j.jinf.2014.05.005 ◽

2014 ◽

Vol 69 (3) ◽

pp. 216-225 ◽

Cited By ~ 152

Author(s):

Katherine K. Perez ◽

Randall J. Olsen ◽

William L. Musick ◽

Patricia L. Cernoch ◽

James R. Davis ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Rapid Diagnostics ◽

Antibiotic Resistant ◽

Gram Negative ◽

Gram Negative Bacteremia

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Oral fluoroquinolones for definitive treatment of gram-negative bacteremia in cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-021-06063-6 ◽

2021 ◽

Author(s):

Justin C. Tossey ◽

Zeinab El Boghdadly ◽

Erica E. Reed ◽

Jennifer Dela-Pena ◽

Kelci Coe ◽

...

Keyword(s):

Cancer Patients ◽

Definitive Treatment ◽

Gram Negative ◽

Gram Negative Bacteremia

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Antibiotic-resistant Gram-negative Bacteria in Urban Flies, and the Increased Risk Posed by Open-air Markets in Mexico City

Microbiology Research Journal International ◽

10.9734/mrji/2021/v31i630328 ◽

2021 ◽

pp. 62-70

Author(s):

Carlos F. Amábile-Cuevas ◽

Daniel Romero-Romero

Keyword(s):

Mexico City ◽

Resistant Bacteria ◽

Urban Dispersion ◽

Carriage Rate ◽

Antibiotic Resistant ◽

Gram Negative ◽

E Coli ◽

Increased Risk ◽

Class 1 ◽

Open Air Markets

Aims: Flies are known to spread antibiotic resistant bacteria (ARB), especially from farms to cities; but they may also play a role in the intra-urban dispersion of ARB, in conjunction with poor sanitary conditions. Here, we characterized gram-negative ARB isolated from urban flies (Lucilia and Sarcophaga spp.), and the co-relation with the periodic installation of two open-air markets in Mexico City. Methodology: Forty-two flies were individually captured, and 116 gram-negatives (68 of them Escherichia coli) were isolated from them. Resistance prevalence, and the presence of class 1 integrons was assessed. Results: The isolates were resistant to an average of 2.26 antibiotics (2.6 for E. coli), and 33% of E. coli isolates carried the intI1 gene. Thirteen percent of E. coli isolates produced extended-spectrum beta-lactamases (ESBL), all of them CTX-M, alone or, mostly, along TEM enzymes. Comparing data from market-free days vs. days when open-air markets were installed, the average number of resistance phenotypes per E. coli isolate went from 2.14 to 3.09; the number of resistance phenotypes per fly from 4.62 to 8.88; the average number of resistances per isolate per fly from 1.25 to 2.43; and the ESBL-producing carriage rate per fly from 0.08 to 0.38, respectively (P <.05). Other resistance parameters, were consistently higher among flies captured on market days, but differences were not significant. Conclusion: Urban flies in Mexico City carry a high number of gram-negative ARB; the presence of open-air markets significantly increase the risk of fly-mediated ARB spreading to the neighboring areas.

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