Current practice of screening and antimicrobial prophylaxis to prevent Gram-negative bacterial infection in high-risk haematology patients: results from a pan-European survey.
[en] [en] BACKGROUND: Bacterial infections frequently occur in haematological patients, especially during prolonged neutropenia after intensive chemotherapy, often leading to bloodstream infections and pneumonia.
OBJECTIVE: Routine antimicrobial prophylaxis (AMP) for high-risk haematology patients is still debated while prevalence of multi-drug resistant (MDR) Gram-negative bacteria (GNB) is rising globally. We aimed to assess the current practice of AMP in this population.
DESIGN: Cross-sectional observational survey study.
METHODS: Haematologists and infectious diseases physicians Europewide were invited to an online survey including questions on routine screening for GNB, incidence of MDR-GNB colonization, antimicrobial prophylaxis practices, rates of bloodstream infections (BSI), ICU admission and mortality differentiated by infections due to GNB versus MDR-GNB.
RESULTS: 120 haematology centres from 28 countries participated. Screening for MDR-GNB is performed in 86.7% of centres, mostly via rectal swabs (58.3%). In 39.2% of routine AMP is used, mostly with fluoroquinolones. Estimates of GNB-BSI yielded higher rates in patients not receiving anti-GNB prophylaxis than in those who do for E. coli (10% vs 7%) Klebsiella spp. (10% vs 5%), and Pseudomonas spp. (5% vs 4%). Rates for MDR-GNB infection were estimated lower in centres that administer AMP for MDR E. coli (5% vs 3%) Klebsiella spp. (5% vs 3%), and Pseudomonas spp. (2% vs 1%). In an exploratory analysis, Southern and Eastern European countries expected higher rates of MDR-GNB infections with lower ICU admission and mortality rates which may be subject to estimation bias.
CONCLUSION: Screening for MDR-GNB is frequently performed. AMP against GNB infections is still often implemented. Estimated BSI rates are rather low, while the rate of MDR-GNB infections rises. Tailored prophylaxis including antimicrobial stewardship becomes more important.
Disciplines :
Immunology & infectious disease
Author, co-author :
Stemler, Jannik; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany ; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
Gavriilaki, Eleni; 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Hlukhareva, Oksana; Clinical Center of Oncology, Hematology, Transplantology and Palliative Care of Cherkasy Oblast Council, Cherkasy, Ukraine
Khanna, Nina; Division of Infectious Diseases and Hospital Epidemiology, Departments of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
Neofytos, Dionysios; Division of Infectious Diseases, Transplant Infectious Disease Service, University Hospital of Geneva, Geneva, Switzerland
Akova, Murat; Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Pagano, Livio; Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
Cisneros, José-Miguel; Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
Cornely, Oliver A; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany ; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany ; University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
Salmanton-García, Jon ; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ; Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany ; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Herderstraße 52, Cologne 50931, Germany
Other collaborator :
LAYIOS, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Language :
English
Title :
Current practice of screening and antimicrobial prophylaxis to prevent Gram-negative bacterial infection in high-risk haematology patients: results from a pan-European survey.
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