Current Practice of Screening and Antimicrobial Prophylaxis to Prevent Gram-negative Bacterial Infection in High-risk Haematology Patients: Results from a Pan-European Survey

Overview

Journal Ther Adv Infect Dis

Publisher Sage Publications

Specialty Infectious Diseases

Date 2024 Nov 4

PMID 39493728

Authors

Jannik Stemler

Eleni Gavriilaki

Oksana Hlukhareva

Nina Khanna

Dionysios Neofytos

Murat Akova

Livio Pagano

Jose-Miguel Cisneros

Oliver A Cornely

Jon Salmanton-Garcia

Affiliations

Soon will be listed here.

Abstract

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 (10% vs 7%) spp. (10% vs 5%), and spp. (5% vs 4%). Rates for MDR-GNB infection were estimated lower in centres that administer AMP for MDR (5% vs 3%) spp. (5% vs 3%), and 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.

References

Rodriguez-Bano J, Gutierrez-Gutierrez B, Machuca I, Pascual A . Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. Clin Microbiol Rev. 2018; 31(2). PMC: 5967687. DOI: 10.1128/CMR.00079-17. View

Leibovici L, Paul M, Cullen M, Bucaneve G, Gafter-Gvili A, Fraser A . Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions. Cancer. 2006; 107(8):1743-51. DOI: 10.1002/cncr.22205. View

Morgan D, Diekema D, Sepkowitz K, Perencevich E . Adverse outcomes associated with Contact Precautions: a review of the literature. Am J Infect Control. 2009; 37(2):85-93. PMC: 3557494. DOI: 10.1016/j.ajic.2008.04.257. View

Cornely O, Schirmacher P . Clinical picture: Bacterial translocation in neutropenic sepsis. Lancet. 2001; 358(9296):1842. DOI: 10.1016/s0140-6736(01)06884-2. View

Vehreschild M, Hamprecht A, Peterson L, Schubert S, Hantschel M, Peter S . A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies. J Antimicrob Chemother. 2014; 69(12):3387-92. DOI: 10.1093/jac/dku305. View

Mikulska M, Averbuch D, Tissot F, Cordonnier C, Akova M, Calandra T . Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. J Infect. 2017; 76(1):20-37. DOI: 10.1016/j.jinf.2017.10.009. View

Willems R, van Dijk K, Vehreschild M, Biehl L, Ket J, Remmelzwaal S . Incidence of infection with multidrug-resistant Gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis. Lancet Infect Dis. 2023; 23(6):719-731. DOI: 10.1016/S1473-3099(22)00811-8. View

Papadimitriou-Olivgeris M, Marangos M, Fligou F, Christofidou M, Sklavou C, Vamvakopoulou S . KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality. Diagn Microbiol Infect Dis. 2013; 77(2):169-73. DOI: 10.1016/j.diagmicrobio.2013.06.007. View

Classen A, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff L . Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and.... Ann Hematol. 2021; 100(6):1603-1620. PMC: 8116237. DOI: 10.1007/s00277-021-04452-9. View

10.

Liss B, Cornely O . Burden and benefit of antibiotic prophylaxis in cancer chemotherapy. Lancet Infect Dis. 2016; 16(6):640. DOI: 10.1016/S1473-3099(16)30056-1. View

11.

Marra A, Edmond M, Schweizer M, Ryan G, Diekema D . Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis. Am J Infect Control. 2017; 46(3):333-340. DOI: 10.1016/j.ajic.2017.08.031. View

12.

Teillant A, Gandra S, Barter D, Morgan D, Laxminarayan R . Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015; 15(12):1429-37. DOI: 10.1016/S1473-3099(15)00270-4. View

13.

Barbier F, Pommier C, Essaied W, Garrouste-Orgeas M, Schwebel C, Ruckly S . Colonization and infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure?. J Antimicrob Chemother. 2016; 71(4):1088-97. DOI: 10.1093/jac/dkv423. View

14.

Biehl L, Higgins P, Wille T, Peter K, Hamprecht A, Peter S . Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards. Clin Microbiol Infect. 2019; 25(8):1013-1020. DOI: 10.1016/j.cmi.2018.12.029. View

15.

Harris A, Pineles L, Belton B, Johnson J, Shardell M, Loeb M . Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA. 2013; 310(15):1571-80. PMC: 4026208. DOI: 10.1001/jama.2013.277815. View

16.

Taur Y, Pamer E . The intestinal microbiota and susceptibility to infection in immunocompromised patients. Curr Opin Infect Dis. 2013; 26(4):332-7. PMC: 4485384. DOI: 10.1097/QCO.0b013e3283630dd3. View

17.

Slavin M, Worth L, Seymour J, Thursky K . Better Sepsis Management Rather Than Fluoroquinolone Prophylaxis for Patients With Cancer-Related Immunosuppression. J Clin Oncol. 2019; 37(13):1139-1140. DOI: 10.1200/JCO.18.01474. View

18.

Merdad R, Alyami A, Basalim A, Alzahrani A, Aldainiy A, Awadh A . Bloodstream gram-negative bacterial infections in adult patients with leukemia: A retrospective review of medical records in a tertiary care hospital in Western Saudi Arabia. J Infect Public Health. 2023; 16(10):1525-1530. DOI: 10.1016/j.jiph.2023.07.010. View

19.

Frencken J, Wittekamp B, Plantinga N, Spitoni C, van de Groep K, Cremer O . Associations Between Enteral Colonization With Gram-Negative Bacteria and Intensive Care Unit-Acquired Infections and Colonization of the Respiratory Tract. Clin Infect Dis. 2017; 66(4):497-503. DOI: 10.1093/cid/cix824. View

20.

Taplitz R, Kennedy E, Bow E, Crews J, Gleason C, Hawley D . Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol. 2018; 36(30):3043-3054. DOI: 10.1200/JCO.18.00374. View