Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; the value of a surveillance-culture-guided empirical therapy approach

Abstract ObjectivesAmong 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.MethodsUsing 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.ResultsWe 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.ConclusionsThis multi-centre study shows that in patients with haematological malignancy, the majority of 3GCR-GNB bacteraemia is preceded by 3GCR-GNB colonization. This approach thereby reduces the risk of inappropriately treated 3GCR-GNB bacteraemia without the necessity to administer carbapenems to all high-risk neutropenic patients with fever.