항암화학요법을 받은 혈액질환자에서 발생한 호중구감소성 균혈증에서 경험적 항생제 내성의 위험인자분석
Risk Factors for Resistance to Empirical Antibiotic Therapy in Bacteremia in Neutropenic Patients Undergoing Chemotherapy for Hematologic Diseases
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Background : Broad-spectrum antibiotics including those with anti-pseudomonal activity are recommended based on regional and institutional epidemiologic antimicrobial-resistance profiles when selecting empirical antibiotics for febrile neutropenia. We have used ceftizoxime with amikacin as empirical antibiotics for patients with neutropenic fever. To prescribe the appropriate empirical antibiotics, periodic analysis of the current status of febrile neutropenia and the causative microorganisms is required. We analyzed the risk factors for infection resistance to ceftizoxime with amikacin in bacteremic febrile neutropenia among patients undergoing chemotherapy. Methods : We retrospectively reviewed bloodstream infections in patients undergoing treatment for acute leukemia or hematopoietic stem cell transplantation from July 1, 2014, to June 30, 2019. Early treatment response was assessed 7 days after the onset of bacteremia by the negative conversion of follow-up blood cultures, improved C-reactive protein (CRP) levels, and defervescence. Multivariate logistic regression was used to evaluate the risk factors associated with antibiotic-resistant infection. Results : A total of 190 bacteremia episodes were identified. The majority of the bacteria [142 (74.7%)] were gram-negative, and 11 (5.7%) were Pseudomonas aeruginosa. Ceftizoxime with amikacin (43.6%) and piperacillin with tobramycin (23.2%) was mainly used as the empirical antibiotics. The 30-day mortality was found to be 3.1%. Among 174 patients assessed for early treatment response, most of them (98.2%) showed favorable responses including the negative conversion of blood cultures, improved CRP levels (85.0%), and defervescence (81.6%). Multivariate logistic regression analysis showed that exposure to third-generation antibiotics, cephalosporin (p=0.012) or piperacillin/tazobactam (p=0.048) within 30 days prior to the onset of bacteremia were independent risk factors for infections resistant to treatment with ceftizoxime with amikacin. Conclusion : When considering ceftizoxime with amikacin as the empirical antibiotics of choice, it should be noted that exposure to antibiotics such as third-generation cephalosporin or piperacillin/ tazobactam is limited to within 30 days prior to the onset of bacteremia.
Abstract
Background : Broad-spectrum antibiotics including those with anti-pseudomonal activity are recommended based on regional and institutional epidemiologic antimicrobial-resistance profiles when selecting empirical antibiotics for febrile neutropenia. We have used ceftizoxime with amikacin as empirical antibiotics for patients with neutropenic fever. To prescribe the appropriate empirical antibiotics, periodic analysis of the current status of febrile neutropenia and the causative microorganisms is required. We analyzed the risk factors for infection resistance to ceftizoxime with amikacin in bacteremic febrile neutropenia among patients undergoing chemotherapy. Methods : We retrospectively reviewed bloodstream infections in patients undergoing treatment for acute leukemia or hematopoietic stem cell transplantation from July 1, 2014, to June 30, 2019. Early treatment response was assessed 7 days after the onset of bacteremia by the negative conversion of follow-up blood cultures, improved C-reactive protein (CRP) levels, and defervescence. Multivariate logistic regression was used to evaluate the risk factors associated with antibiotic-resistant infection. Results : A total of 190 bacteremia episodes were identified. The majority of the bacteria [142 (74.7%)] were gram-negative, and 11 (5.7%) were Pseudomonas aeruginosa. Ceftizoxime with amikacin (43.6%) and piperacillin with tobramycin (23.2%) was mainly used as the empirical antibiotics. The 30-day mortality was found to be 3.1%. Among 174 patients assessed for early treatment response, most of them (98.2%) showed favorable responses including the negative conversion of blood cultures, improved CRP levels (85.0%), and defervescence (81.6%). Multivariate logistic regression analysis showed that exposure to third-generation antibiotics, cephalosporin (p=0.012) or piperacillin/tazobactam (p=0.048) within 30 days prior to the onset of bacteremia were independent risk factors for infections resistant to treatment with ceftizoxime with amikacin. Conclusion : When considering ceftizoxime with amikacin as the empirical antibiotics of choice, it should be noted that exposure to antibiotics such as third-generation cephalosporin or piperacillin/ tazobactam is limited to within 30 days prior to the onset of bacteremia.
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