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Bacteremia in patients with hematological malignancies
Fu-Der Wang1, Mei-Lin Lin, Cheng-Yi Liu
1Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. fdwang@vghtpe.gov.tw
Chemotherapy
|May 12, 2005
Summary
Empirical antibiotic therapy for neutropenic fever in hematologic malignancy patients should be guided by local resistance patterns. Cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, or imipenem are recommended for Gram-negative bacilli (GNB) bacteremia.
Area of Science:
- Infectious Diseases
- Hematology
- Clinical Microbiology
Background:
- Empirical therapy for neutropenic fever requires institutional-specific antimicrobial regimens.
- Understanding local microbial isolate patterns and antibiotic resistance is crucial for effective treatment.
Purpose of the Study:
- To investigate bacteremia isolates and their antibiotic susceptibility in patients with hematological malignancies.
- To identify risk factors for mortality in this patient population.
Main Methods:
- Evaluation of positive blood cultures from hematologic malignancy patients (1999-2002) in a Taiwanese medical center.
- Antimicrobial activity testing of eleven antibiotics.
- Assessment of mortality risk factors.
Main Results:
- 371 bacteremia episodes in 266 patients were recorded.
- Gram-negative bacilli (GNB) predominated (78.2%), with Escherichia coli being the most common isolate.
- Susceptibility was highest to cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, or imipenem. Age, GNB, and inadequate empirical antibiotics were risk factors for mortality.
Conclusions:
- Cefoperazone/sulbactam, piperacillin/tazobactam, cefepime, or imipenem are suggested as ideal empirical therapies.
- Individualized treatment based on local antibiograms is essential for neutropenic fever management.