TY - JOUR
T1 - The epidemiology of bacteremia with febrile neutropenia
T2 - Experience from a single center, 1988-2004
AU - Paul, Mical
AU - Gafter-Gvili, Anat
AU - Leibovici, Leonard
AU - Bishara, Jihad
AU - Levy, Itzhak
AU - Yaniv, Isaac
AU - Shalit, Itamar
AU - Samra, Zmira
AU - Pitlik, Silvio
AU - Konigsberger, Hanna
AU - Weinberger, Miriam
PY - 2007/6
Y1 - 2007/6
N2 - Background: The epidemiology of bacteremic febrile neutropenia differs between locations and constitutes the basis for selection of emrpiric antibiotic therapy for febrile neutropenia. Objectives: To describe the epidemiology of bacteremia among patients with neutropenia in a single center in Israel. Methods: We conducted a prospective data collection on all patients with neutropenia (< 500/mm3) and clinically significant bactetiemia or fungemia during the period 1988-2004. Results: Among adults (462 episodes) the most common bloodstream isolate was Esherichia coli. Gram-negative bacteria predominated throughout the study period and the ratio between Gram-negative and Gram-positive bacteremia increased from 1.7 to 2.3. Among children (752 episodes), the ratio between Gram-negative and Gram-positive bacteremia reversed from 1.2 to 0.7, due to increasing prevalence of coagulase-negative staphylcoccal bacteremia. Both among adults and children, the length of hospital stay prior to bacteremia had a major impact on the pathogens causing bacteremia and their antibiotic susceptibilities. The prevalence of E. coli decreased with time in hospital, while the rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp., Enterococcus spp. and Candida spp, increased. Resistance to broad-spectrum empiric monotherapy in our center was observed in > 40% of Gram-negative bacteria when bacteremia was acquired aftet 14 days in hospital. Conclusions: Improved infection-control measures for neutropenic cancer patients in our center are needed. Empiric antibiotic treatment should be tailored to patients' risk for multidrug-resistant organisms. Individual hospitals should monitor infection epidemiology among cancer patients to guide empiric antibiotic treatment.
AB - Background: The epidemiology of bacteremic febrile neutropenia differs between locations and constitutes the basis for selection of emrpiric antibiotic therapy for febrile neutropenia. Objectives: To describe the epidemiology of bacteremia among patients with neutropenia in a single center in Israel. Methods: We conducted a prospective data collection on all patients with neutropenia (< 500/mm3) and clinically significant bactetiemia or fungemia during the period 1988-2004. Results: Among adults (462 episodes) the most common bloodstream isolate was Esherichia coli. Gram-negative bacteria predominated throughout the study period and the ratio between Gram-negative and Gram-positive bacteremia increased from 1.7 to 2.3. Among children (752 episodes), the ratio between Gram-negative and Gram-positive bacteremia reversed from 1.2 to 0.7, due to increasing prevalence of coagulase-negative staphylcoccal bacteremia. Both among adults and children, the length of hospital stay prior to bacteremia had a major impact on the pathogens causing bacteremia and their antibiotic susceptibilities. The prevalence of E. coli decreased with time in hospital, while the rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp., Enterococcus spp. and Candida spp, increased. Resistance to broad-spectrum empiric monotherapy in our center was observed in > 40% of Gram-negative bacteria when bacteremia was acquired aftet 14 days in hospital. Conclusions: Improved infection-control measures for neutropenic cancer patients in our center are needed. Empiric antibiotic treatment should be tailored to patients' risk for multidrug-resistant organisms. Individual hospitals should monitor infection epidemiology among cancer patients to guide empiric antibiotic treatment.
KW - Antibiotic resistance
KW - Bloodstream infections
KW - Cross-infection
KW - Febrile neutropenia
KW - Hospital epidemiology
UR - http://www.scopus.com/inward/record.url?scp=34250854631&partnerID=8YFLogxK
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AN - SCOPUS:34250854631
SN - 1565-1088
VL - 9
SP - 424
EP - 429
JO - Israel Medical Association Journal
JF - Israel Medical Association Journal
IS - 6
ER -