Publication Date:
2010-11-19
Description:
Abstract 4868 Introduction: Bacteremia is a major cause of morbidity and mortality in patients with hematological disorders during chemotherapy-induced neutropenia. Initial antimicrobial treatment is chosen empirically. Increasing antimicrobial resistance is a global obstacle for improving outcome for hematological patients. The aim of this study was to compare temporal trends in species distribution and antimicrobial susceptibility in bacteremic patients hospitalized in a hematology ward at Karolinska University Hospital, Stockholm, Sweden, over a 21-year period. Materials and methods: A total of 794 clinically significant isolates, 667 clinical episodes of bacteremia in 463 patients were identified during the last 7 years and the results were compared with those published from the same ward during the preceding 14 years. Isolates and episodes were identified from the laboratory information system, which has been in use during the entire 21-year period. For coagulase-negative staphylococci (CoNS), Corynebacterium spp., Propionibacterium spp. and Bacillus spp. bacteremia was considered significant only if the isolates were detected in two or more blood specimens. No major changes in patient selection were introduced during these 21 years and quinolone prophylaxis was used only to a very limited extent. Results: Any shift between Gram-negative and Gram-positive bacteria has not been noted at any time and the proportion of Gram-positive isolates has remained at a level of 53–55%. In the last 7-year period the male patient predominance increased from 58% to 62%, and the median age increased from 58 to 62 years. The 7- and 30-day crude mortality rates were 5.3% and 14.8%, respectively, compared with 6.3% and 16% in the preceding 7-year period (p〉0.05). Polymicrobial bacteremia, defined as growth of more than one organism during the same bacteremic episode within 24 hours or 72 hours, was seen in 13.7% and 14.8% of patients respectively, compared to 11% (24 hours) in the preceding 7-year period (p〉0.05). Polymicrobial bacteremia was seen in 25% and 28% respectively of patients who died within 7 days. Crude mortality at day 7 in patients with polymicrobial bacteremia was significantly higher than for patients with monomicrobial bacteremia (p=
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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