Article
Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa
Registro en:
GUDIOL, C. et al. Clinical predective model of multidrug resistence in neutrophenic cancer patients with bloodstream infection due to Pseudomonas aeruginosa. Antimicrobial Agents of Chemotherapy, v. 64, n. 4, e02494-19, p. 1-12, Apr. 2020.
0066-4804
10.1128/AAC.02494-19
1098-6596
10.1128/AAC02494-19
Autor
Gudiol, C.
Albasanz-Puig, A.
Laporte-Amargòs, J.
Pallarés, N.
Mussetti, A.
Ruiz-Camps, I.
Puerta-Alcade, P.
Abdala, Edson
Oitolini, C.
Akova, M.
Montejo, M.
Mikulska, M.
Martin-Dávila, P.
Herrera, F.
Gasch, O.
Drgona, L.
Morales, H. Paz
Brunel, A.-S.
Garcia, E.
Isler, B.
Kern, W. V.
Morales, I.
Maestro--dela Calle, G.
Montero, M.
Kanj, S. S.
Sipahi, O. R.
Calik, S.
Mpaquez-Gómez, I.
Marin, J. I.
Gomes, M. Z. R.
Hemmatti, P.
Peghin, M.
Pozo, J. L. del
Ýanez, L.
Tilley, R.
Manzur, A.
Novo, A.
Carrtalá, J.
Resumen
Background: We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa (PA) in neutropenic cancer patients. Methods: We performed a multicenter, retrospective cohort study including onco-hematological neutropenic patients with BSI due to PA conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict multidrug resistance of the causative pathogens. Results: Of a total of 1217 episodes of BSI due to PA, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (p=0.033). Predictors of MDRPA BSI were prior therapy with piperacillin/tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29-5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65-3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92-4.64), underlying hematological disease (OR, 2.09 95% CI, 1.26-3.44) and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65-3.91), whereas older age (OR, 0.98; 95% CI, 0.97-0.99) was found to be protective. Conclusions: Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDRPA. The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients, who may benefit from the early administration of a broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at low risk of resistance.