Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa.
Details
Serval ID
serval:BIB_5AEDF943A0A9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa.
Journal
Antimicrobial agents and chemotherapy
Working group(s)
IRONIC Study Group
Contributor(s)
Cuervo G., Escrihuela-Vidal F., Tubau F., Tebé C., Rodríguez Arias M., Aguilar-Company J., Larrosa N., Cardozo C., Garcia-Vidal C., Karim-Yaqub I., Greco R., Cichero P., Ayaz C.M., Céspedes R., López-Soria L., Magnasco L., Fortún J., Torres D., Boté A., Espasa M., Hold Montaguti M., Bochud P.Y., Manuel O., Tabares Carrasco S., Serrano López J., Bertz H., Rieg S., de Cueto M., Rodríguez-Baño J., Lizasoain M., Aguado J.M., Horcajada J.P., El Zein S., Jabbour J.F., Uyan-Onal A., Nazli-Zeka A., Palop B., Correa L.C., Machado AADS, Tonhá JPS, Maschmeyer G., Munita J., Bassetti M., Castaldo N., Del Alcázar P.S.
ISSN
1098-6596 (Electronic)
ISSN-L
0066-4804
Publication state
Published
Issued date
24/03/2020
Peer-reviewed
Oui
Volume
64
Number
4
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Abstract
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development.
Keywords
Anti-Bacterial Agents/therapeutic use, Bacteremia/drug therapy, Bacteremia/microbiology, Drug Resistance, Multiple, Bacterial, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Models, Biological, Neoplasms/complications, Neoplasms/microbiology, Neutropenia/complications, Neutropenia/microbiology, Pseudomonas Infections/drug therapy, Pseudomonas Infections/microbiology, Pseudomonas aeruginosa/drug effects, ROC Curve, Retrospective Studies, Risk Factors, Treatment Outcome, Pseudomonas aeruginosa, bacteremia, bloodstream infection, cancer, multidrug resistant, neutropenia, predictive model, risk factors
Pubmed
Web of science
Create date
06/02/2020 17:27
Last modification date
17/02/2024 7:12