Reference : Changing pattern of bacterial susceptibility to antibiotics in hematopoietic stem cel...
Scientific journals : Article
Human health sciences : Hematology
Changing pattern of bacterial susceptibility to antibiotics in hematopoietic stem cell transplant recipients.
Frere, Pascale mailto [Centre Hospitalier Universitaire de Liège - CHU > > Hématologie clinique >]
Hermanne, J.-P. mailto [> > > >]
Debouge, M.-H. [> > > >]
Fillet, Georges mailto [Centre Hospitalier Universitaire de Liège - CHU > > Hématologie clinique >]
Beguin, Yves mailto [Centre Hospitalier Universitaire de Liège - CHU > > Hématologie clinique >]
Bone Marrow Transplantation
Nature Publishing Group
Yes (verified by ORBi)
United Kingdom
[en] Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents/pharmacology ; Bacteria/drug effects/isolation & purification ; Bacterial Infections/drug therapy/microbiology/prevention & control ; Belgium ; Carbapenems/pharmacology ; Cephalosporins/pharmacology ; Ciprofloxacin/pharmacology ; Drug Resistance ; Drug Resistance, Multiple, Bacterial ; Enterococcus/drug effects ; Follow-Up Studies ; Gram-Negative Bacteria/drug effects ; Hematopoietic Stem Cell Transplantation ; Humans ; Microbial Sensitivity Tests/statistics & numerical data ; Retrospective Studies ; Staphylococcus/drug effects ; Streptococcus/drug effects ; Transplantation, Autologous ; Transplantation, Homologous
[en] Adequate infection prophylaxis and empirical antibiotic therapy are of critical importance after hematopoietic stem cell transplantation (HSCT). We examined the evolution of bacterial susceptibility to antibiotics in 492 patients (198 allografts and 294 autografts) transplanted between 1982 and 1999 and evaluated whether ciprofloxacin prophylaxis and an empirical antibiotic regimen (glycopeptide + third-generation cephalosporin) were still valid. We collected all susceptibility tests performed during the initial hospitalization on blood cultures as well as routine surveillance cultures and analyzed susceptibility to ciprofloxacin and to major antibiotics used in our unit. Gram-positive cocci rapidly became resistant to ciprofloxacin (susceptibility around 70% in 1990 to less than 20% in 1998) but sensitivity to glycopeptides remained unaltered. There was a rapid decline in the number of patients colonized with Gram-negative bacilli in the early years of ciprofloxacin prophylaxis. However, susceptibility to ciprofloxacin fell sharply from around 90% in 1990 to around 30% in 1999. In parallel, susceptibility to ceftazidime also decreased to less than 80% in recent years. Piperacillin (+/- tazobactam) did not show any variation over time and its efficacy remained too low (about 60%). Imipenem as well as recently introduced cefepim and meropenem showed stable and excellent profiles (>90% susceptibility). In conclusion: (1) quinolone prophylaxis has now lost most of its value; (2) the choice of a third-generation cephalosporin for empirical antibiotic therapy may no longer be the best because of the emergence of Gram-negative strains resistant to beta-lactamases, such as Enterobacter sp. More appropriate regimens of empirical antibiotic therapy in HSCT recipients may be based on the use of a carbapenem or fourth-generation cephalosporin.

File(s) associated to this reference

Fulltext file(s):

Open access
158.pdfPublisher postprint86.32 kBView/Open

Bookmark and Share SFX Query

All documents in ORBi are protected by a user license.