Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy and rationale for surveillance- culture-guided empirical therapy; results from an 11-year multi-centre retrospective study

Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative pathogens to third-generation cephalosporins is increasing. We aimed to provide rationale for surveillance-culture-guided (SCG) empirical therapy for this population. Methods Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of third-generation cephalosporin resistant Gram-negative bacteria (3GCR-GNB) in episodes of bacteraemia, and the proportion of 3GCR-GNB bacteraemia that was preceded by 3GCR-GNB colonization (identified using surveillance cultures) in the year before. Results We included 3,887 patients, representing 4,142 episodes of bacteraemia. GNB were identified in 715/4,142 (17.3%), of which 221 (30.9%) were 3GCR-GNB. In (106/139) 76.2% of patients with a 3GCR-GNB bacteraemia and available GNB surveillance cultures in the preceding year, 3GCR-GNB colonization had been previously identified. Conclusions This multi-centre study shows that in patients with haematological malignancy, the majority of 3GCR-GNB bacteraemia is preceded by 3GCR-GNB colonization. To restrict empirical carbapenem use, surveillance-culture-guided empirical therapy is a viable strategy, against the background of high 3GCR rates.