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Changing microbial epidemiology in hematopoietic stem cell transplant recipients: increasing resistance over a 9‐year period
Author(s) -
Macesic N.,
Morrissey C.O.,
Cheng A.C.,
Spencer A.,
Peleg A.Y.
Publication year - 2014
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12298
Subject(s) - medicine , microbiology and biotechnology , neutropenia , odds ratio , hematopoietic stem cell transplantation , enterococcus , population , antibiotic resistance , acinetobacter , acinetobacter baumannii , antibiotics , pseudomonas aeruginosa , transplantation , biology , bacteria , chemotherapy , genetics , environmental health
Infections remain important contributors to mortality in hematopoietic stem cell transplantation ( HSCT ). Method We studied the evolving epidemiology and trends in susceptibility of bacterial and C andida isolates at an A ustralian HSCT center. A total of 528 HSCT s in 508 patients were performed from A pril 2001 to M ay 2010. A total of 605 isolates were eligible for study inclusion; 318 (53%) were gram‐positive, 268 (44%) were gram‐negative, and 19 (3%) were C andida species. Results The most common site for isolates was blood (380 isolates, 63%). S taphylococcus aureus was the most common gram‐positive organism ( n = 107, 34%), but trends to increasing coagulase‐negative staphylococci ( P = 0.002) and vancomycin‐resistant E nterococcus ( P < 0.001) were observed. E scherichia coli was the most common gram‐negative isolate ( n = 74, 28%). Fluoroquinolone resistance increased with widespread use of protocol fluoroquinolone prophylaxis ( P = 0.001). Carbapenem resistance was found in 44% of P seudomonas or A cinetobacter isolates. Bloodstream infection with a multidrug‐resistant organism (odds ratio 3.61, 95% confidence interval: 1.40–9.32, P = 0.008) was an independent predictor of mortality at 7 days after a positive blood culture. Conclusions Antimicrobial resistance is an increasing problem in this vulnerable patient population, and not only has an impact on choice of empiric therapy for febrile neutropenia but also on mortality.