#43: Monotherapy Experience in Pediatric Patients with High-risk Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S19-S19
Author(s):  
Valentina Gutiérrez ◽  
Ximena Claverie
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Fungal Infections ◽  
Clinical Signs ◽  
Empiric Therapy ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Third Line ◽  
Clinical Worsening

Abstract Background Fever during neutropenia is a common occurrence in children with cancer. In a systematic review of RCTs of pediatric febrile neutropenia, compared monotherapy with aminoglycoside-containing combination therapy found no significant differences in failure rates, infection-related mortality, or overall mortality. The updated pediatric-specific guidelines recommend initiation of empirical antibiotic monotherapy using an antipseudomonal β-lactam, a fourth-generation cephalosporin, or a carbapenem for pediatric high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. Our local hospital epidemiology does not have Pseudomonas aeruginosa isolates, therefore, we used ceftriaxone as monotherapy in patients with high-risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third-generation cephalosporins in these patients. Methods Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until November 2019. Results We found a total of 133 high-risk febrile neutropenia episodes corresponding to 50 patients, 78% were leukemia and 22% were solid tumor patients. Of the 133 episodes, 92 (69%) had clinical signs at admission, mostly respiratory in 46 (50%) of the cases, 18 (29%) had mucositis and 13 (14%) had diarrhea. Of 133 episodes, 41 (31%) did not have any source at clinical examination. Eighty-six (65%) cases started ceftriaxone at admission, 28 (33%) maintained ceftriaxone for 7 days of treatment with good clinical response. Of this group 58 (67%) patients changed treatment: 32 (37%) cases started second-line antibiotics for clinical worsening, 19 (22%) cases required second- and third-line antibiotics for persistent fever and clinical worsening, and 7 (8%) received third-line antibiotics from the start for past microbiological history. Sixteen (12%) cases of total evolved with sepsis requiring intensive care unit management. We had 30 (23%) episodes with positive blood culture, 11 (37%) due to gram-positive bacteria, 16 (53%) gram-negative bacteria, and 3 (10%) cases of fungal infections. Of the gram-negative bacteria, 7 (44%) were ESBL producers, without P. aeruginosa isolates. One case died (0.7%) for refractory sepsis due to gram-negative bacteria. Conclusion Although we did not have P. aeruginosa isolates, due to the spread of ESBL strains, monotherapy with ceftriaxone is not a good option as initial therapy for high-risk febrile neutropenia patients. The empiric therapy has to be evaluated regularly and should always be based on local epidemiology.

scholarly journals 1107. Third Generation Cephalosporins Monotherapy Experience in Pediatric Patients with High-Risk Febrile Neutropenia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S584-S584
Author(s):  
Valentina Gutierrez ◽  
Ximena Claverie
Keyword(s):  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Pediatric Patients ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Gram Negative ◽  
Third Line ◽  
Third Generation Cephalosporins ◽  
Clinical Worsening

Abstract Background Fever during neutropenia is common in children with cancer. The updated guidelines recommend empirical antibiotic monotherapy using an antipseudomonal ß-lactam, a fourth generation cephalosporin or a carbapenem for high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. In our hospital there are not Pseudomonas aeruginosa isolates in oncology pediatric patients, therefore, we use ceftriaxone as monotherapy in high risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third generation cephalosporins in these patients. Methods Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until December 2019. Results We found 140 episodes in 53 patients, 42 (79%) were leukemia and 11 (21%) solid tumor patients. Of the 140 episodes, 97 (69%) had clinical signs at admission, mostly respiratory in 48 (49%) of the cases. Ninety one (65%) cases started ceftriaxone at admission, 27 (30%) maintained ceftriaxone for 7 days of treatment. Sixty four (70%) cases changed treatment: 38/64 (42%) started second line antibiotics for clinical worsening, 19/64 (20%) required second and third line antibiotics for persistent fever and clinical worsening, and 7/64 (8%) received third line antibiotics from the start for past microbiological history. Eighteen (13%) cases evolved with sepsis requiring intensive care unit management.We had 32 (23%) episodes with positive blood culture, 13 (41%) due to gram positive bacteria, 16 (50%) gram negative bacteria, and 3 (9%) cases of fungal infections. Of the gram negative bacteria, 7 (44%) were ESBL producers, without Pseudomonas aeruginosa isolates.One case died (0.7%) for refractory sepsis due to gram negative bacteria. Conclusion Monotherapy with ceftriaxone is not a good option as initial therapy for high risk febrile neutropenia patients due to the spread of ESBL strains. The empiric therapy has to be evaluated regularly and should always be based in local epidemiology. Disclosures All Authors: No reported disclosures

How fluoroquinolone preauthorization affects third- and fourth-generation cephalosporin use and resistance in a large academic hospital

2021 ◽  
pp. 1-12
Author(s):  
Adeniyi J. Idigo ◽  
Matthew L. Brown ◽  
Howard W. Wiener ◽  
Russell L. Griffin ◽  
Yuanfan Ye ◽  
...  
Keyword(s):  
Regression Models ◽  
Interrupted Time Series ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Academic Hospital ◽  
Gram Negative ◽  
Hospital Acquired Infections ◽  
Quasi Experimental ◽  
Hospital Acquired

Abstract Objective: We observed an overall increase in the use of third- and fourth-generation cephalosporins after fluoroquinolone preauthorization was implemented. We examined the change in specific third- and fourth-generation cephalosporin use, and we sought to determine whether there was a consequent change in non-susceptibility of select Gram-negative bacterial isolates to these antibiotics. Design: Retrospective quasi-experimental study. Setting: Academic hospital. Intervention: Fluoroquinolone preauthorization was implemented in the hospital in October 2005. We used interrupted time series (ITS) Poisson regression models to examine trends in monthly rates of ceftriaxone, ceftazidime, and cefepime use and trends in yearly rates of nonsusceptible isolates (NSIs) of select Gram-negative bacteria before (1998–2004) and after (2006–2016) fluoroquinolone preauthorization was implemented. Results: Rates of use of ceftriaxone and cefepime increased after fluoroquinolone preauthorization was implemented (ceftriaxone RR, 1.002; 95% CI, 1.002–1.003; P < .0001; cefepime RR, 1.003; 95% CI, 1.001–1.004; P = .0006), but ceftazidime use continued to decline (RR, 0.991, 95% CI, 0.990–0.992; P < .0001). Rates of ceftazidime and cefepime NSIs of Pseudomonas aeruginosa (ceftazidime RR, 0.937; 95% CI, 0.910–0.965, P < .0001; cefepime RR, 0.937; 95% CI, 0.912–0.963; P < .0001) declined after fluoroquinolone preauthorization was implemented. Rates of ceftazidime and cefepime NSIs of Enterobacter cloacae (ceftazidime RR, 1.116; 95% CI, 1.078–1.154; P < .0001; cefepime RR, 1.198; 95% CI, 1.112–1.291; P < .0001) and cefepime NSI of Acinetobacter baumannii (RR, 1.169; 95% CI, 1.081–1.263; P < .0001) were increasing before fluoroquinolone preauthorization was implemented but became stable thereafter: E. cloacae (ceftazidime RR, 0.987; 95% CI, 0.948–1.028; P = .531; cefepime RR, 0.990; 95% CI, 0.962–1.018; P = .461) and A. baumannii (cefepime RR, 0.972; 95% CI, 0.939–1.006; P = .100). Conclusions: Fluoroquinolone preauthorization may increase use of unrestricted third- and fourth-generation cephalosporins; however, we did not observe increased antimicrobial resistance to these agents, especially among clinically important Gram-negative bacteria known for hospital-acquired infections.

scholarly journals Bloodstream infections in patients with hematologic malignancies and febrile neutropenia - a single center experience

2021 ◽  
Vol 74 (3-4) ◽  
pp. 83-89
Author(s):  
Marina Dragicevic-Jojkic ◽  
Ivana Urosevic ◽  
Amir El Farra ◽  
Borivoj Sekulic ◽  
Ivanka Percic ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Fatal Outcome ◽  
Antibiotic Sensitivity ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
High Rate ◽  
Antibiotics Resistance ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Acinetobacter Spp

Introduction. Bacterial blood infections during febrile neutropenia episodes are urgent medical conditions which were and still are the main cause of morbidity and mortality among patients with hematologic malignancies. The aim of this study was to determine the incidence and clinical characteristics of bacteremia, infectious agents, presence and incidence of antibiotic resistance, as well as the treatment outcome of bloodstream infections in patients with hematologic malignancies. Material and Methods. A three-year retrospective study included 107 patients with hematologic malignancies and positive blood culture results during febrile neutropenia. Results. The most common isolates were Gram-negative bacteria (58.5%), with Escherichia coli being the most frequent pathogen. The Gram-negative microorganisms were mostly sensitive to carbapenems in 70.7%, whereas sensitivity to other antibiotics was as follows: piperacillin/ tazobactam 62%, amikacin 58.5%, and third-generation cephalosporins 50.5%. Acinetobacter spp. was sensitive only to colistin (94.1%). The antibiotic sensitivity among Gram-positive bacteria was highest to linezolid (97.1%), followed by teicoplanin (81.4%) and vancomycin (81.4%). In our patients, the mortality rate during the first 28 days from the moment of positive isolates was high (37.4%). Most patients died within the first seven days. Bacterial blood infections caused by Gram-negative bacteria were associated with significantly higher mortality (?2 = 4.92, p = 0.026). Acinetobacter spp. was isolated in almost half of the patients with fatal outcome, of whom 62.5% died in the first 24 hours. Conclusion. Bacterial bloodstream infections are severe complications with a high rate of mortality in febrile neutropenic hematological patients. Gram-negative bacteria were the most common isolates in our Clinic, with high mortality. It is of utmost importance to constantly monitor the resistance of bacteria to antibiotics, as well as to prevent and control the spread of resistant strains. Antibiotics resistance patterns should regularly be followed.

scholarly journals Prevalence of gram negative bacteria in infected burn wounds and antibiotic susceptibility pattern; a study conducted on stable burn patients reporting to out-patient department.

2021 ◽  
Vol 28 (10) ◽  
pp. 1376-1380
Author(s):  
Saeeda Nabat ul Hassan ◽  
Khushbu Farva ◽  
Ghulam Asghar Bhutta
Keyword(s):  
Antibiotic Susceptibility ◽  
Clinical Signs ◽  
Gram Negative Bacteria ◽  
Burn Patients ◽  
Susceptibility Pattern ◽  
Antibiotic Susceptibility Pattern ◽  
Gram Negative ◽  
Burn Wounds ◽  
Study Results ◽  
Patient Department

Objective: To study prevalence of various gram negative bacteria in infected burn wounds among stable burn patients reporting to out-patient department on follow-ups. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Patients with burn wounds with clinical signs and symptoms of infection but vitally stable, wound less than one month old involving < 20% body surface, reporting to out-patient door of study institution on follow-ups were enrolled into the study. Swabs of infected wounds were taken and sent for bacterial culture and sensitivity to the pathology department of the institution, where micro flora were isolated and their antibiotic susceptibility pattern was determined using standard techniques. Consent was taken from patients before including them in study. Results: Total 210 cases were studied. Gram negative bacteria were isolated from 190 cases, out of them 30% were oxidase positive ad 70% were oxidase negative. Most common organism isolated was Pseudomonas Aeruginosa (30%), followed by Proteus Sps. (25.3%) and Entero bacter Sps. (15.8%) etc. Conclusion: Among gram negative bacteria pseudomonas is a major isolated organism from infected burn wounds having high susceptibility to imipenem and cefepime.

scholarly journals Resistome in gram-negative bacteria from soft cheese in Brazil

2020 ◽  
Vol 19 (3) ◽  
pp. 430
Author(s):  
Cristiane Rodrigues Silva ◽  
Newton Takeshi Okuno ◽  
Victor Hugo Lima de Medeiros Macedo ◽  
Isabela Da Rocha Freire ◽  
Rafael Monção Miller ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
High Rate ◽  
Fourth Generation ◽  
Specific Method ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Pcr Screening ◽  
Soft Cheese ◽  
Class 1 ◽  
Phenotypic Susceptibility

<p class="SemEspaamento11"><strong>ABSTRACT</strong></p><p class="SemEspaamento11"><strong> </strong></p><p class="SemEspaamento11"><strong>Objectives:</strong> evaluation of antibiotic resistance in Gram-negative microbiota from ready-to-eat cheese samples.</p><p><strong>Methodology: </strong>this research applied a specific method to evaluate the phenotypic susceptibility to antibiotics in a viable Gram-negative microbiota. The selected food was a cheese that is commonly consumed without thermal processing, the Minas Frescal cheese. The evaluation was followed by a PCR screening in this resistant microbiota, for genes that provide resistance to antibiotics and also to the quaternary ammonium.</p><p><strong>Results: </strong>all cheese samples demonstrated a resistant microbiota. In 13.3% of the cheese samples analyzed, the resistance reached all ten different antibiotics tested and, in 80%, 8 to 10 different antibiotics. In antibiotics considered critics as the carbapenems: ertapenem presented resistant microbiota in 86.7% of the samples. In cephalosporins, the resistance reached 100% in the third generation (ceftazidime) and almost half of the samples (46.7%) in the fourth generation (cefepime). In genotypic research, seven different resistance genes were found in 69.2% of the bacterial pools, including the beta-lactamase-producing genes ctx, tem, shv, tetracycline resistant genes and a high rate of integrons class 1 and 2.</p><strong>Conclusions: </strong>the results indicate phenotypically and genotypically that the Minas frescal cheese can present potential resistant microbiota. Therefore, the methodology used is a viable possibility and with a broader answer about the food microbiota role in resistance. This research corroborates the food area as an important sector to be managed to reduce the process of antibiotic resistance.

scholarly journals Antimicrobial resistance of gram-negative pathogens isolated from hospitalized patients in Rostov region

2020 ◽  
Vol 22 (2) ◽  
pp. 143-148
Author(s):  
Olga Yu. Kutsevalova ◽  
Yu.Yu. Kozel ◽  
D.A. Rozenko ◽  
D.V. Martynov ◽  
O.V. Korshunkova
Keyword(s):  
High Resistance ◽  
Hospitalized Patients ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Central Research ◽  
Gram Negative ◽  
Beta Lactamases ◽  
E Coli ◽  
Microbiological Methods ◽  
Resistance Rates

Objective. To evaluate resistance rates to carbapenems and III–IV generation cephalosporins among gramnegative bacteria, including production of carbapenemases and extended-spectrum beta-lactamases (ESBL). Materials and Methods. A total of 460 gram-negative bacteria isolated from hospitalized patients aged 1 to 85 years from 8 medical institutions of Rostov-on-Don and the region from April 2018 to December 2019 were tested by conventional microbiological methods. The most common acquired carbapenemases genes were determined by real-time PCR using commercial kits (Central Research Institute of Epidemiology, Russia). Results. The tested isolates included 180 (39.1%) isolates of K. pneumoniae, 87 (18.9%) – E. coli, 101 (22.0%) – A. baumannii and 92 (20.0%) – P. aeruginosa. K. pneumoniae and E. coli isolates exhibited the high resistance rates to cefotaxime – 96.7% and 71.2%, to ceftazidime – 95.5% and 54.0%, and to cefepime – 95.5% and 54.0%, respectively. ESBL production was detected in 35.0% and 78.2% of K. pneumoniae and E.coli isolates, respectively. K. pneumoniae and E. coli isolates were resistant to imipenem, meropenem, and ertapenem: 57.8% and 3.4%; 55.0% and 2.3%; 60.0% and 4.6%, respectively. Carbapenemase production was detected in 27.8% of K. pneumoniae and 4.6% of E. coli isolates. The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-48). A. baumannii isolates showed the high resistance rates to imipenem and meropenem (87.1% and 85.1%). The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-24⁄40 and OXA-23). P. aeruginosa isolates also showed the high resistance to carbapenems – imipenem (61.9%) and meropenem (58.7%). The most common betalactamases were metallo-beta-lactamases (VIM) and GES-5. Conclusions. The results of this microbiological study indicate the extremely high prevalence of aerobic gram-negative bacteria in different infections. A. baumannii, P. aeruginosa, K. pneumoniae and E. coli isolates being resistant to third- and fourth-generation cephalosporins and carbapenems are particularly dangerous, especially due to production of ESBL and carbapenemases. The most clinically important are OXA and NDM beta-lactamases.

Catalyst Free and Energy Economical Synthesis of Thiazole Derivatives Bearing Azo Imine Linkage with Imidazole as Antimicrobial Agents

2019 ◽  
Vol 16 (3) ◽  
pp. 284-290
Author(s):  
Nayan M. Panchani ◽  
Hitendra S. Joshi
Keyword(s):  
Antibacterial Activity ◽  
Room Temperature ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Gram Negative Bacteria ◽  
Thiazole Derivatives ◽  
Microbial Diseases ◽  
Gram Negative ◽  
In Vitro Antibacterial Activity

Background:Several strategies have been reported for the synthesis of thiazole derivatives.Methods:However, many of these methods suffer from several drawbacks. Several modifications have been made to counter these problems. Here, we have synthesized a new series of 2-(2-((1HImidazol- 4-yl)methylene)hydrazinyl)-4-(4-substitutedphenyl)thiazoles without using the catalyst at room temperature.Results:The structures of synthesized compounds have been confirmed by spectral analysis, such as Mass, IR, 1H NMR and 13C NMR. All synthesized compounds were screened for in vitro antibacterial activity against some gram-positive and gram-negative bacteria.Conclusion:The thiazole derivatives, with a pharmacologically potent group, discussed in this article may provide valued therapeutic important in the treatment of microbial diseases, especially against bacterial and fungal infections.

A Novel Risk Predictive Scoring Model For Predicting Subsequent Infection After Carbapenem-Resistant Gram-Negative Bacteria Colonization In Hematological Malignancies Patients

2021 ◽  
Author(s):  
Qiuling Wu ◽  
Chenjing Qian ◽  
Hua Ying ◽  
Fang Liu ◽  
Yaohui Wu ◽  
...  
Keyword(s):  
High Risk ◽  
Hematological Malignancies ◽  
Risk Group ◽  
High Risk Group ◽  
Gram Negative Bacteria ◽  
Clinical Infection ◽  
Subsequent Infection ◽  
Gram Negative ◽  
Scoring Model ◽  
Carbapenem Resistant

Abstract PurposeTo investigate the high-risk factors associated with the increased vulnerability for subsequent clinical infection in Carbapenem-resistant Gram-negative bacteria (CR-GNB) colonized hematological malignancies (HMs) patients, and build a statistical model to predict subsequent infection.MethodAll adult HMs patients with positive anal swab culture for CR-GNB between January 2018 and June 2020 were prospectively followed to assess for any subsequent CR-GNB infections and to investigate the risk factors and clinical features of subsequent infection.ResultsA total of 392 HMs patients were enrolled. Of them, 46.7% developed a subsequent clinical infection, and 42 (10.7%) were confirmed infection and 141 (36%) were clinically diagnosed infection. Klebsiella pneumoniae was the dominant species. The overall mortality rate of patients colonized and infected with CR-GNB was 8.6% and 43.7%. A multivariate analysis showed that remission induction chemotherapy, the duration of agranulocytosis, mucositis, and hypoalbuminemia were significant predictors of subsequent infection after CR-GNB colonization. According to our novel risk predictive scoring model, the high-risk group were > 3 times more likely to develop a subsequent infection in comparison with the low-risk group.ConclusionOur risk predictive scoring model can early and accurately predict subsequent infection in HMs patients with CR-GNB colonization. Early administration of CR-GNB-targeted empirical therapy in the high-risk group is strongly recommended to decrease their mortality.

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