A. Soriano

Epidemiology and outcome of bacteraemia in neutropenic patients in a single institution from 1991-2012.

This study was part of a bloodstream infection surveillance programme that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2012. We included 2092 bacteraemias in neutropenic patients. Shock and mortality accounted for 299 and 349 cases, respectively (14% and 17%). The main microorganisms isolated were coagulase-negative staphylococci (CoNS, 634, 30%), Escherichia coli (468, 22%) and Pseudomonas aeruginosa (235, 11%). During 2006-2012, there were 155 (27%) E. coli isolates; of these, 73% were fluoroquinolone resistant and 26% cefotaxime resistant. The independent risk factors for mortality were shock on presentation, rapidly fatal prognosis of underlying disease, corticosteroid use, and polymicrobial bacteraemia. Factors associated with lower mortality were the isolation of CoNS [odds ratio (OR) 0·38, 95% confidence interval (CI) 0·20-0·73, P = 0·004] and empirical therapy with amikacin (OR 0·50, 95% CI 0·29-0·88, P = 0·016). The progressive increase of Gram-negative microorganisms resistant to antibiotics influences the choice of empirical treatment in febrile neutropenia and in our experience, the addition of amikacin could be beneficial for such patients.

Risk factors for the isolation of a third generation cephalosporin resistant strain in patients with community-acquired Enterobacteriaceae bacteraemia

We read with great interest the recent study of Shaw et al. regarding the epidemiology and outcome of severe sepsis in community-onset bacteraemic urinary tract infection. We congratulate the authors for their excellent work. Extended-spectrum b-lactamases (ESBL) are plasmidmediated b-lactamases that confer resistance to oxyiminocephalosporins and monobactams and have been increasingly described worldwide since their first description in the early 1980s, especially among Enterobacteriaceae isolates, and recently not only in the nosocomial, but also in the community setting. Shaw et al. reported 34 EEscherichia coli and 7 K. pneumoniae ESBL-producing strains. The aim of present study is to describe the prevalence and the main characteristics of community-acquired bacteraemia caused by third generation cephalosporin resistant (CTX-R) Enterobacteriaceae, as well as to identify the risk factors for these infections in our setting. The study was conducted in a 700-bed university centre that provides specialized and broad medical, surgical, and intensive care for an urban population of 500,000 people. The present report refers to all adult patients ( 18 years old) attending the emergency department with Enterobacteriaceae (E. coli or Klebsiella spp) monomicrobial community-acquired bacteraemia recorded from January 2001 to December 2013. The Ethics Committee board of our institution approved the study. The following data were obtained from all patients: age, gender, comorbidities, McCabe classification of underlying diseases, treatment with antibiotics or steroids in the previous month, recent hospitalization (within the last month), surgery and other invasive procedures, source of bacteraemia, shock on presentation, etiologic microorganisms, empirical antibiotic treatment, appropriateness of empirical therapy, and mortality (evaluated at 7 and 30 days).