Ceftriaxone-resistant viridans streptococci bacteraemia among patients treated at a large comprehensive cancer care centre: a retrospective eighteen-year study.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-08-05 eCollection Date: 2024-08-01 DOI:10.1093/jacamr/dlae126
Paula Marsland, Rupali Jain, Frank Tverdek, Paul Hendrie, Catherine Liu, Steven A Pergam, Lori Bourassa
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Abstract

Objectives: Viridans streptococci (VS) are opportunistic oral commensals and a common cause of bacteraemia in neutropenic patients. In this retrospective single centre cohort study, we investigated the prevalence of ceftriaxone resistance in VS (CRO-R VS) blood isolates between January 2005 and December 2022 from patients treated at a tertiary care hospital.

Methods: Blood culture isolates were identified using biochemicals and mass spectrometry. Susceptibility testing was performed by Kirby-Bauer and Epsilometer tests. Demographic data, clinical outcomes and antimicrobial use were assessed through electronic medical record review.

Results: Among 791 patients with VS bacteraemia, 31 (4%) had confirmed CRO-R VS bacteraemia over the 18-year period; 20/31 (65%) were patients also treated at the Fred Hutchinson Cancer Center and were the focus of this study. Of these 20 patients, 18 (90%) had a known haematologic malignancy; 14 (70%) had undergone haematopoietic cell transplant (HCT); 18 (90%) were neutropenic at the time of culture. Two (10%) patients died within 30 days of CRO-R VS bacteraemia. All the CRO-R isolates (20/20) were members of the Streptococcus mitis group, 12 were multi-drug resistant; all were susceptible to vancomycin. Most patients received vancomycin once blood cultures were positive for a Gram-positive organism.

Conclusions: During the study period, the frequency of VS isolate susceptibility testing increased; however, there was no concomitant increase in the percentage of CRO-R isolates at our facility. These data are important in an era where cefepime monotherapy is often used and reinforces the importance of routine resistance testing among VS bacteraemia.

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在一家大型综合癌症护理中心接受治疗的患者中出现的耐头孢曲松病毒性链球菌菌血症:一项为期十八年的回顾性研究。
目的:病毒性链球菌(VS)是一种机会性口腔共生菌,也是导致中性粒细胞减少患者发生菌血症的常见原因。在这项回顾性单中心队列研究中,我们调查了 2005 年 1 月至 2022 年 12 月期间在一家三级医院接受治疗的患者血液分离物中头孢曲松耐药性(CRO-R VS)的流行情况:方法:采用生化分析和质谱分析法对血培养分离物进行鉴定。采用柯比鲍尔试验和埃普西勒试验进行药敏试验。通过查阅电子病历对人口统计学数据、临床结果和抗菌药物使用情况进行评估:在 791 名 VS 菌血症患者中,有 31 人(4%)在 18 年间确诊为 CRO-R VS 菌血症;其中 20/31 人(65%)也是在弗雷德-哈钦森癌症中心接受治疗的患者,是本研究的重点对象。在这 20 名患者中,18 人(90%)患有已知的血液恶性肿瘤;14 人(70%)接受过造血细胞移植 (HCT);18 人(90%)在培养时患有中性粒细胞减少症。两名(10%)患者在 CRO-R VS 菌血症 30 天内死亡。所有的 CRO-R 分离物(20/20)都属于肝炎链球菌,其中 12 个具有多重耐药性;所有分离物都对万古霉素敏感。一旦血液培养出革兰氏阳性菌,大多数患者都会接受万古霉素治疗:结论:在研究期间,VS 分离物药敏试验的频率增加了;但在我们的医疗机构,CRO-R 分离物的比例并没有随之增加。在经常使用头孢吡肟单一疗法的时代,这些数据非常重要,同时也加强了在 VS 菌血症中进行常规耐药性检测的重要性。
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CiteScore
5.30
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审稿时长
16 weeks
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