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עמוד בית
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June 2007
M. Paul, A. Gafter-Gvili, L. Leibovici, J. Bishara, I. Levy, I. Yaniv, I. Shalit Z, Samra, S. Pitlik, H. Konigsberger and M. Weinberger

Background: The epidemiology of bacteremic febrile neutropenia differs between locations and constitutes the basis for selection of empiric antibiotic therapy for febrile neutropenia.

Objectives: To describe the epidemiology of bacteremia among patients with neutropenia in a single center in Israel.

Methods: We conducted a prospective data collection on all patients with neutropenia (< 500/mm3) and clinically significant bacteremia or fungemia during the period 1988–2004.

Results: Among adults (462 episodes) the most common bloodstream isolate was Esherichia coli. Gram-negative bacteria predominated throughout the study period and the ratio between Gram-negative and Gram-positive bacteremia increased from 1.7 to 2.3 throughout the study period. Among children (752 episodes), the ratio between Gram-negative and Gram-positive bacteremia reversed from 1.2 to 0.7, due to increasing prevalence of coagulase-negative staphylcoccal bacteremia. Both among adults and children, the length of hospital stay prior to bacteremia had a major impact on the pathogens causing bacteremia and their antibiotic susceptibilities. The prevalence of E. coli decreased with time in hospital, while the rates of Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter spp., Enterococcus spp. and Candida spp. increased. Resistance to broad-spectrum empiric monotherapy in our center was observed in > 40% of Gram-negative bacteria when bacteremia was acquired after 14 days in hospital.
Conclusions: Improved infection-control measures for neutropenic cancer patients in our center are needed. Empiric antibiotic treatment should be tailored to patients’ risk for multidrug-resistant organisms. Individual hospitals should monitor infection epidemiology among cancer patients to guide empiric antibiotic treatment

May 2005
J. Bishara, G. Livne, S. Ashkenazi, I. Levy, S. Pitlik, O. Ofir, B. Lev and Z. Samra

Background: The prevalence of extended-spectrum β-lactamase-producing organisms and their antimicrobial resistance patterns may vary between geographic areas.

Objectives: To evaluate the prevalence and susceptibility of ESBL[1]-producing organisms among Klebsiella pneumoniae and Escherichia coli isolated from adult and pediatric patients in two Israeli hospitals.

Methods: ESBL production was tested according to recommendations of the Clinical and Laboratory Standards Institute, using ceftazidime (30 μg) and a combination of ceftazidime/clavulanate (30/10 μg) disks with a ≥5 mm difference indicating positivity. Antibiotic susceptibilities were determined by the disk diffusion method according to CLSI[2] standards. Minimum inhibitory concentrations were determined by the E-test.

Results: The prevalence of ESBL-producing organisms was significantly higher among K. pneumoniae than E. coli isolates – 32% (241/765) vs. 10% (57/547) respectively (P < 0.001), and more frequently isolated from adults than children (odds ratio 2.27 for K. pneumoniae and 12.94 for E. coli). Resistance rates for amoxicillin/clavulanate, piperacillin-tazobactam, amikacin, and ciprofloxacin among the ESBL-producing K. pneumoniae and E. coli isolates were 95%, 82%, 49% and 77% for K. pneumoniae, and 77%, 35%, 25% and 100% for E. coli. Two (0.8%) ESBL-producing and 4 (0.7%) ESBL-negative K. pneumoniae isolates showed intermediate susceptibility (MIC[3] 6 μg/ml) to meropenem. All isolates were sensitive to ertapenem and colistin.  

Conclusion: ESBL production among K. pneumoniae and E. coli is more prevalent in the adult population than the pediatric population and is associated with multidrug resistance.







[1] ESBL = extended spectrum β-lactamase

[2] CLSI = Clinical and Laboratory Standards Institute (formerly the NCCLS)

[3] MIC = minimum inhibitory concentration





 

September 1999
Ben Zion Garty, MD, Itzhak Levy, MD, and Zvi Laron, MD.
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