@article{10902/30388,
year = {2023},
url = {https://hdl.handle.net/10902/30388},
abstract = {Optimal coverage of Pseudomonas aeruginosa is challenging in febrile neutropenic patients due to a progressive increase in antibiotic resistance worldwide. We aimed to detail current rates of resistance to antibiotics recommended by international guidelines for P. aeruginosa isolated from bloodstream infections (BSI) in patients with hematologic malignancies. Secondarily, we aimed to describe how many patients received inappropriate empirical antibiotic treatment (IEAT) and its impact on mortality. We conducted a retrospective, multicenter cohort study of the last 20 BSI episodes caused by P. aeruginosa in patients with hematologic malignancies from across 14 university hospitals in Spain. Of the 280 patients with hematologic malignancies and BSI caused by P. aeruginosa, 101 (36%) had strains resistant to at least one of the b-lactam antibiotics recommended in international guidelines, namely, cefepime, piperacillin-tazobactam, and meropenem. Additionally, 21.1% and 11.4% of the strains met criteria for MDR and XDR P. aeruginosa, respectively. Even if international guidelines were followed in most cases, 47 (16.8%) patients received IEAT and 66 (23.6%) received inappropriate b-lactam empirical antibiotic treatment. Thirty-day mortality was 27.1%. In the multivariate analysis, pulmonary source (OR 2.22, 95% CI 1.14 to 4.34) and IEAT (OR 2.67, 95% CI 1.37 to 5.23) were factors independently associated with increased mortality. We concluded that P. aeruginosa-causing BSI in patients with hematologic malignancies is commonly resistant to antibiotics recommended in international guidelines, which is associated with frequent IEAT and higher mortality. New therapeutic strategies are needed.},
organization = {ACKNOWLEDGMENTS. This work was cofunded by a research grant (SGR 01324 Q5856414G) from the AGAUR (Agencia de Gestión de Ayudas Universitarias y de Investigación) of Catalunya. P.P.-A. [JR20/00012 and PI21/00498], and C.G.-V. [FIS PI21/01640] have received research grants funded by the Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union. MSD provided financial support for medical writing assistance of this paper. The funders had neither a specific role in study design or collection of data, nor in writing of the paper or decision to submit. C.G.-V. has received honoraria for talks on behalf of Gilead Science, MSD, Novartis, Pfizer, Janssen, and Lilly as well as a grant from Gilead Science and MSD. A.S. has received honoraria for talks on behalf of Merck Sharp and Dohme, Pfizer, Novartis, Angellini, as well as grant support from Pfizer. P.P.-A. has received honoraria for talks on behalf of Merck Sharp and Dohme, Gilead, Lilly, ViiV Healthcare, and Gilead Science. We thank Anthony Armenta for providing medical editing assistance for the manuscript at hand. We thank OP postdoctoral fellow financial support: la Ligue Nationale contre le Cancer (convention number: AAPMRC 2022/OP) and la Direction de l'Assistance Publique-Hôpitaux de Paris (APHP).},
publisher = {ASM Press},
publisher = {Microbiology Spectrum, 2023, 11, 4},
title = {High rate of inappropriate antibiotics in patients with hematologic malignancies and pseudomonas aeruginosa cacteremia following international guideline recommendations},
author = {Chumbita, Mariana and Puerta-Alcalde, Pedro and Yáñez San Segundo, Lucrecia and Cuesta, María Ángeles and Chinea, Anabelle and Español-Morales, Ignacio and Fernández-Abellán, Pascual and Gudiol, Carlota and González-Sierra, Pedro and Rojas, Rafael and Sánchez-Pina, José María and Sánchez Vadillo, Irene and Sanchez, Miguel and Varela, Rosario and Vázquez, Lourdes and Guerreiro, Manuel and Monzo, Patricia and Lopera, Carlos and Aiello, Tommaso Francesco and Peyrony, Oliver},
}