Infections post transplant Changing pattern of bacterial susceptibility to antibiotics in hematopoietic stem cell transplant recipients

Summary: Adequate infection prophylaxis and empirical antibiotic therapy are of critical importance after hematopoietic stem cell transplantation (HSCT). We examined the evolution of bacterial susceptibility to antibiotics in 492 patients (198 allografts and 294 autografts) transplanted between 1982 and 1999 and evaluated whether ciprofloxacin prophylaxis and an empirical antibiotic regimen (glycopeptide + third-generation cephalosporin) were still valid. We collected all susceptibility tests performed during the initial hospitalization on blood cultures as well as routine surveillance cultures and analyzed susceptibility to ciprofloxacin and to major antibiotics used in our unit. Gram-positive cocci rapidly became resistant to ciprofloxacin (susceptibility around 70% in 1990 to less than 20% in 1998) but sensitivity to glycopeptides remained unaltered. There was a rapid decline in the number of patients colonized with Gramnegative bacilli in the early years of ciprofloxacin prophylaxis. However, susceptibility to ciprofloxacin fell sharply from around 90% in 1990 to around 30% in 1999. In parallel, susceptibility to ceftazidime also decreased to less than 80% in recent years. Piperacillin ( tazobactam) did not show any variation over time and its efficacy remained too low (about 60%). Imipenem as well as recently introduced cefepim and meropenem showed stable and excellent profiles (90% susceptibility). In conclusion: (1) quinolone prophylaxis has now lost most of its value; (2) the choice of a thirdgeneration cephalosporin for empirical antibiotic therapy may no longer be the best because of the emergence of Gram-negative strains resistant to -lactamases, such as Enterobacter sp. More appropriate regimens of empirical antibiotic therapy in HSCT recipients may be based on the use of a carbapenem or fourth-generation cephalosporin. Bone Marrow Transplantation (2002) 29, 589–594. DOI:

[1]  J. Baumgartner,et al.  [Evaluation of antibiotic prophylaxis in neutropenic patients with hematologic malignancies]. , 2000, Schweizerische medizinische Wochenschrift.

[2]  Ronald N. Jones,et al.  In vitro efficacy of six cephalosporins tested against Enterobacteriaceae isolated at 38 North American medical centres participating in the SENTRY Antimicrobial Surveillance Program, 1997-1998. , 2000, International journal of antimicrobial agents.

[3]  J. Sobel,et al.  Antibiotics for gram-positive bacterial infections. Vancomycin, teicoplanin, quinupristin/dalfopristin, and linezolid. , 2000, Infectious disease clinics of North America.

[4]  M. Laseur,et al.  A prospective, randomized, double-blinded, placebo-controlled trial of empirical teicoplanin in febrile neutropenia with persistent fever after imipenem monotherapy. , 2000, The Journal of antimicrobial chemotherapy.

[5]  D. Landman,et al.  Antimicrobial resistance in Enterobacteriaceae in Brooklyn, NY: epidemiology and relation to antibiotic usage patterns. , 2000, The Journal of antimicrobial chemotherapy.

[6]  Murray Be.  Problems and perils of vancomycin resistant enterococci. , 2000 .

[7]  R. Jones.  Perspectives on the development of new antimicrobial agents for resistant gram-positive pathogens. , 2000, The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases.

[8]  D. Monnet,et al.  Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. , 2000, International journal of antimicrobial agents.

[9]  C. J. Thomson,et al.  High Prevalence of Extended Spectrum Beta-Lactamase Production Among Klebsiella pneumoniae Strains Isolated at a University Hospital in Turkey , 2000, Journal of chemotherapy.

[10]  D. Livermore,et al.  Epidemiology of antibiotic resistance , 2000, Intensive Care Medicine.

[11]  S. Yeh,et al.  Oral ciprofloxacin as antibacterial prophylaxis after allogeneic bone marrow transplantation: a reappraisal , 1999, Bone Marrow Transplantation.

[12]  I. Tabbara,et al.  Empiric antimicrobial therapy of febrile neutropenic patients undergoing haematopoietic stem cell transplantation. , 1999, International journal of antimicrobial agents.

[13]  J. Faoagali,et al.  Isolation of beta-lactamase positive vancomycin resistant Enterococcus faecalis; first case in Australia. , 1999, Communicable diseases intelligence.

[14]  J. Finke,et al.  An open, randomized, multicentre study comparing the use of low-dose ceftazidime or cefotaxime, both in combination with netilmicin, in febrile neutropenic patients. German Multicentre Study Group. , 1999, The Journal of antimicrobial chemotherapy.

[15]  J. Pechère.  Sélection de résistance sous la pression des nouveaux antibiotiques , 1999 .

[16]  A. Bosi,et al.  An open evaluation of triple antibiotic therapy including vancomycin for febrile bone marrow transplant recipients with severe neutropenia. , 1999, Journal of chemotherapy.

[17]  H. Goossens,et al.  Decreasing antibiotic resistance of Enterobacteriaceae by introducing a new antibiotic combination therapy for neutropenic fever patients , 1998, Leukemia.

[18]  K. K. Lai,et al.  Failure to Eradicate Vancomycin-Resistant Enterococci in a University Hospital and the Cost of Barrier Precautions , 1998, Infection Control & Hospital Epidemiology.

[19]  L. Young,et al.  1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  S. Cohen,et al.  The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I beta-lactamase-producing organisms. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  A. Chow,et al.  Prospective randomized trial of piperacillin monotherapy versus carboxypenicillin-aminoglycoside combination regimens in the empirical treatment of serious bacterial infections , 1983, Antimicrobial Agents and Chemotherapy.