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Previous antibiotic use, length of stay influence cefepime resistance in febrile neutropenic patients

Issue: October 2011

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Bacterial resistance in hematology wards was found to be related to health care and influenced by previous antibiotic use and length of stay in febrile neutropenic patients, according to research presented here.

Researchers assessed risk factors for cefepime resistance (CFP-R) at the onset of fever in a hematology ward from January 2008 to June 2010. They established a scoring system to predict CFP-R at bedside to indicate when additional antibiotics could be useful until bacterial documentation.

Using recommendations from the Comite de l’Antibiogramme de la Société Française de Microbiologie or results from natural resistance, susceptibility testing determined the CFP-R of isolates, according to the study. Researchers used multivariate logistic regression with backward selection for selecting risk factors for CFP-R. CFP-R with internal validation was predicted by a scoring system using the bootstrap resampling technique.

Researchers found an overall rate of 49% (95% CI, 39-59) for CFP-R. Of 155 episodes of bacteremia, 66% of first episodes included 21 Enterobacteriaceae, four Pseudomonas aeruginosa, 35 staphylococci and 25 streptococci. Acute lymphoblastic leukemia (OR=6; P<.04), 18 or more days since hospital admission (OR=4.7; P<.005), and receipt of any beta-lactam in the past month (OR=3.6; P<.04) were risk factors associated with CFP-R, but neutropenia and severe sepsis were not associated with CFP-R. There was an 81% (95% CI, 25-100) chance that febrile hematology patients were carrying a CFP-R if they had two or three of the risk factors.

For more information:

• Maaroufi HE. #1123. Presented at: 2011 Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-20; Chicago.

Disclosure: Dr. Maaroufi reports no relevant financial disclosures.

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