Meryk Andreas, Kropshofer Gabriele, Bargehr Caroline, Knoll Miriam, Hetzer Benjamin, Lass-Flörl Cornelia, Crazzolara Roman
Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
Infect Dis Ther. 2021 Jun;10(2):789-800. doi: 10.1007/s40121-021-00427-5. Epub 2021 Mar 11.
Sufficient empirical antimicrobial therapy in febrile patients with cancer is challenging, owing to the limited arsenal of available antibiotics in an era of growing resistance. Because of the emergence of gram-negative bacteria resistant to ceftazidime and piperacillin, a combination antibiotic therapy was employed that uses meropenem combined with gentamicin and/or vancomycin if the patient further deteriorates.
A retrospective cohort analysis was performed including all patients with catheter-associated bloodstream infections (BSIs) and treated for childhood cancer in a tertiary single centre between 1 January 2000 and 31 June 2018. We calculated the prevalence and the risk for BSIs and compared the in vitro susceptibility to various antimicrobial agents.
Of 653 patients with childhood cancer, 113 patients (17.3%) were identified with a total of 139 BSIs, most of them occurring in patients with leukaemia (n = 90, 64.7%) and were associated with gram-positive bacteria (60.5%). In our cohort, all BSIs with gram-negative bacteria exhibited in vitro susceptibility against meropenem alone without any signs of resistance development. The antibiotic coverage of our meropenem-based combination therapy was also highly effective for gram-positive and non-fermenting bacteria. Thus, BSI-related mortality in all 139 BSI episodes was 1.4%. Clostridium difficile infections (CDIs), as main adverse event of carbapenem usage, occurred in only 16 (2.5%) patients.
Our meropenem-based combination therapy showed sufficient empirical antibiotic coverage in the majority of BSIs (96.4%) and did not result in an increased rate of unwanted side effects or development of antibiotic resistance.
在发热的癌症患者中进行充分的经验性抗菌治疗具有挑战性，这是因为在耐药性不断增加的时代，可用抗生素的种类有限。由于出现了对头孢他啶和哌拉西林耐药的革兰氏阴性菌，如果患者病情进一步恶化，则采用美罗培南联合庆大霉素和/或万古霉素的联合抗生素治疗。
进行了一项回顾性队列分析，纳入了2000年1月1日至2018年6月31日期间在一家三级单中心接受儿童癌症治疗且发生导管相关血流感染（BSI）的所有患者。我们计算了BSI的患病率和风险，并比较了对各种抗菌药物的体外敏感性。
在653例儿童癌症患者中，113例（17.3%）被确诊发生了139次BSI，其中大多数发生在白血病患者中（n = 90，64.7%），且与革兰氏阳性菌有关（60.5%）。在我们的队列中，所有革兰氏阴性菌引起的BSI对单用美罗培南均表现出体外敏感性，没有任何耐药迹象。我们基于美罗培南的联合治疗方案对革兰氏阳性菌和非发酵菌的抗菌覆盖也非常有效。因此，在所有139次BSI发作中，与BSI相关的死亡率为1.4%。艰难梭菌感染（CDI）作为碳青霉烯类药物使用的主要不良事件，仅发生在16例（2.5%）患者中。
我们基于美罗培南的联合治疗方案在大多数BSI（96.4%）中显示出足够的经验性抗菌覆盖，且未导致不良副作用发生率增加或出现抗生素耐药性。
