Trends and Antimicrobial Resistance of Pathogens Causing Bloodstream Infections among Febrile Neutropenic Adults with Hematological Malignancy

血液腫瘤白血球數目減少之發燒病患罹患菌血症病原菌種類之分布與抗藥性

陳建源(Chien-Yuan Chen) ； 唐季祿(Jih-Luh Tang) ； 薛博仁(Po-Ren Hsueh) ； 姚明(Ming Yao) ； 黃聖懿(Shang-Yi Huang) ； 陳宜君(Yee-Chun Chen) ； 陳耀昌(Yao-Chang Chen) ； 沈銘鏡(Ming-Ching Shen) ； 蔡偉(Woei Tsai) ； 張上淳(Shan-Chwen Chang) ； 田蕙芬(Hwei-Fang)

《Journal of the Formosan Medical Association》 103卷7期 (2004/07) Pp. 526-532

https://doi.org/10.29828/JFMA.200407.0006

並列摘要

Background and Purpose: The microbiological spectrum in cancer patients with febrile neutropenia has changed over the past several decades in western countries. The growing incidence of antimicrobial resistance is an inevitable consequence of the widespread use of antibiotics in medical settings. The aim of this study was to clarify the trends and antimicrobial resistance among pathogens causing bloodstream infections in febrile neutropenic adults with hematological malignancies.
Methods: The characteristics of pathogens causing bloodstream infection isolated from patients with febrile neutropenia who were treated at National Taiwan University Hospital from 1996 to 2001 were reviewed. A total of 1174 pathogens were isolated from 3093 admissions to a hematological ward during this period. Among them, 738 isolates were recovered from patients with febrile neutropenia.
Results: The majority (93%) of these neutropenic febrile patients had underlying acute leukemia or lymphoma. Gram-negative bacteria accounted for 57% of isolated pathogens, followed by Gram-positive bacteria (32%), fungi (7%), and anaerobes (3%). In decreasing frequency, Escherichia coli (13%), Klebsiella pneumoniae (12%), Enterobacter cloacae (7%), Pseudomonas aeruginosa (6%), and Acinetobacter baumannii (5%) were the predominant Gram-negative
bacteria, while coagulase-negative staphylococci (13%), viridans group streptococci (4%), and Staphylococcus aureus (4%) were the major Gram-positive pathogens. Two-thirds (20/30) of S. aureus isolates were resistant to oxacillin. No vancomycin-resistant enterococci were isolated. Resistance to cefotaxime was found in 63% of E. cloacae, 13% of K. pneumoniae and 10% of E. coli. Overall, 33% of E. coli and 13% of K. pneumoniae were resistant to ciprofloxacin.
Conclusions: This study indicates that the microbiological spectrum of microorganisms causing bloodstream infections in neutropenic febrile patients with hematological malignancies at National Taiwan University Hospital is different from western countries in that Gram-negative bacteria remain the predominant pathogens. Antimicrobial resistance among these pathogens is high and E. coli and K. pneumoniae isolates with resistance to third-generation cephalosporins and ciprofloxacin are increasing.

並列關鍵字

Epidemiology ； Fungemia ； Hematological malignancy ； Neutropenia ； Septicemia ； Taiwan