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Title: Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients
Authors: Oliveira, A. L.
Souza, M. de
Carvalho-Dias, V. M. H.
Ruiz, M. A.
Silla, L.
Tanaka, P. Yurie
Simoes, B. P.
Trabasso, P.
Seber, Adriana [UNIFESP]
Lotfi, C. J.
Zanichelli, Maria A.
Araujo, V. R.
Godoy, C.
Maiolino, Angelo
Urakawa, P.
Cunha, C. A.
De Souza, C. A.
Pasquini, Ricardo
Nucci, Márcio
Universidade Federal do Rio de Janeiro (UFRJ)
Hosp Amaral Carvalho
Univ Fed Parana
Hosp Base
Univ Fed Rio Grande do Sul
Irmandade Santa Casa Misericordia São Paulo
Universidade de São Paulo (USP)
Universidade Estadual de Campinas (UNICAMP)
Universidade Federal de São Paulo (UNIFESP)
Hosp AC Camargo Fund Antonio Prudente
Hosp Brigadeiro
Ctr Pesquisas Oncol
Hosp Araujo Jorge
Keywords: bacteremia
risk factor
Gram negative
bone marrow transplantation
Issue Date: 1-Jun-2007
Publisher: Nature Publishing Group
Citation: Bone Marrow Transplantation. London: Nature Publishing Group, v. 39, n. 12, p. 775-781, 2007.
Abstract: The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third-or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% con. dence interval (CI) 3.75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These. findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.
ISSN: 0268-3369
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