J. Koprnova

Prospective national survey of viridans streptococcal bacteraemia risk factors, antibacterial susceptibility and outcome of 120 episodes

The aim of this study was to prospectively investigate 120 cases of viridans streptococcal bacteraemia (VSB) in 117 patients in major university hospitals in Slovakia in 2000–2002 (3 y) for antibacterial susceptibility, risk factors and outcome. From 127 episodes, 16 (13%) of VSB were caused by PEN-R strains and 13 (10%) by ERY-R strains. 32 cases had cancer as underlying disease (20 haematological), 41 had endocarditis and 35 were elderly (>65 y of age) patients. Concerning mortality, 29 of 127 patients died (24%). There were several risk factors associated with mortality. Solid tumour as underlying disease (p<0.02), stroke (p<0.002), concomitant lung infection (p<0.01), endoscopic procedure (p<0.036), intubation (p<0.0008), ventilatory support (p<0.002), and coma (p<0.009) were associated with more deaths. A comparison of 115 bacteraemias to 13 bacteraemias caused by erythromycin-resistant strains of Streptococcus viridans was performed. There were no significant differences in underlying disease, risk factors and mortality. Erythromycin resistance in bacteraemias caused by S. viridans did not have significant impact on outcome of the patients, nor did it show specific relation to analysed risk factors in our study. 14.5% of VSB were cause by PEN-resistant viridans streptococci. Risk factors for penicillin resistance were ventilatory support (p<0.01), intubation (p<0.001) and resistance to other antibiotics: 8 of 16 (50%) of PEN-R VSB were resistant also to erythromycin or cotrimoxazole or tetracycline compared with 9% of PEN-R VSB (p<0.005). Endoscopic procedures in the upper respiratory system were at risk for development of PEN-R VSB. There was also difference in outcome; 71% vs 22.5% (p<0.0002) of cases infected with PEN-R VSB died compared to PEN-S VSB. PEN-R is therefore clinically significant in VSB.

Stenotrophomonas maltophilia bacteremia

Sir, 30 patients with Stenotrophomonas maltophilia bacteraemia were studies. All isolates of S. maltophilia were resistant to meropenem and 21 (70%) to amikacin, 9 (30%) to ceftazidime and 9 to ciprofloxacin. Practically all isolates (93.3%) were susceptible to cotrimoxazol and 70% also to cefoperazon/sulbactam. We compared clinical characteristics in these patients with this in 164 patients with Pseudomonas aeruginosa bacteraemia and 30 patients with Burkholderia cepacia bacteraemia who were admitted during the same period to 6 major university hospitals in Slovakia to assess differences in risk factors and outcome. All cases of S. maltophilia bacteraemia (SMB) had just one positive blood culture in contrast to B. cepacia, where 20 (66%) of cases had 3 or more positive blood cultures. The most common risk factors identified in patients with S. maltophilia infections were coma (33.3%), vascular catheter infection (20%), and prior surgery (20%). However, none of recorded risk factors except of the lack of multiple positive blood cultures was significantly more frequently observed among patients with S. maltophilia bacteraemia in comparison to those with P. aeruginosa or B. cepacia bacteraemia. However, mortality (47%) was higher than in patients with Pseudomonas aeruginosa bacteraemia (32.5%), or Burkholderia cepacia bacteraemia (20%). These results were in agreement with previously published reports (1, 2).

Bacteremia Due to Pseudomonas aeruginosa: Results from a 3-Year National Study in the Slovak Republic

Abstract Risk factors, mortality and antimicrobial susceptibility of Pseudomonas aeruginosa bacteremias isolated from 148 patients from all University Hospitals in Slovakia were analyzed. Only 1.2% of 169 strains of P. aeruginosa were resistant to meropenem, 4.1% to piperacillin/tazobactam, 7.7% to ceftazidime as well as cefepime and 12% to amikacin. More than 30% of P. aeruginosa were resistant to ciprofloxacin. Our analysis of risk factors for antimicrobial resistance to the particular antimicrobials, indicated no difference in risk factors and outcome in cases infected with P. aeruginosa bacteremias resistant to amikacin, piperacillin/tazobactam or ceftazidime in comparison to episodes caused by P. aeruginosa due to susceptible isolates. When comparing risk factors for P. aeruginosa bacteremia in children vs. adults, cancer vs. non-cancer patients, several differences in risk factors were observed. Neither antimicrobial resistance to amikacin, ceftazidime or piperacillin/tazobactam, nor appropriateness of therapy according to two separate analyses were associated with better outcome.

Acinetobacter baumanii (AB) bacteremia in cancer patients

© Springer-Verlag 2001 Acinetobacter baumanii (AB) is the third most common, gram-negative, bacteremia-causing bacteria in the cancer patient population [1, 2]. In addition, large surveillance studies on nosocomial infections within the past 2 years show an increasing incidence of AB infections worldwide [3, 4, 5]. A total of 157 episodes of AB bloodstream infections in 157 patients from 8 major teaching hospitals (2650 beds) in 5 cities in Slovakia (5.5 million inhabitants) including the National Cancer Institute, National Institute of Heart Diseases, and National Institute of Lung Diseases within 1 year (1999) were evaluated in a nationwide study in Slovakia, and 162 strains of AB were isolated. Of the 157 patients, 58 had cancer as the underlying disease (20 leukemia, 10 lymphoma, 30 solid tumors). In a univariate analysis (EPI INFO 21 statistical package) and multivariate analysis (STATADV 33 computerised package), significant risk factors for AB bacteremia in cancer patients in comparison to all patients from the nationwide survey were neutropenia (p≤0.0001), prior receipt of antineoplastic (p≤0.001), and prior antimicrobial chemotherapy (p≤0.0006) in univariate, but only prior antimicrobial chemotherapy or prophylaxis in the multivariate logistic regression model (p≤0.01; CI 1.2–6.8; RR 2.06) (Table 1). Vice versa, wound infection, prior surgery, and decubital ulcers (p≤0.004–0.0001) as well as ventilatory support were less frequently observed. However, mortality due to cancer (33.9% and 32.9%) was comparable for all of the patients studied within the survey. Concerning the antimicrobial susceptibility of AB isolates from cancer patients, resistance to meropenem among bloodstream isolates in cancer patients was 16%, 30%to cefepime, 42%to ceftazidime, 27.5% to amikacin, 48% to piperacillintazobactam, 30% to cefoperazonsulbactam, 34% to ciprofloxacin, and 52% to aztreonam. Comparing the resistance rates of AB isolates from cancer vs other patients, resistance to ceftazidime (42% vs 24.5%; p≤0.01), piperacillin-tazobactam (72.8% vs 52%; p≤0.009), and aztreonam (52% vs 27.2%; p≤0.001) was significantly higher in cancer patients, probably because of the extensive use of ceftazidime (since 1985) and piperacillin-tazobactam (since 1992) in the empiric therapy of febrile neutropenia in 8 Slovak cancer centers. Support Care Cancer (2001) 9:558–559 DOI 10.1007/s005200100241 L E T T E R T O T H E E D I T O R

Pseudomonas aeruginosa bacteremia in children.

Ps. aeruginosa bacteremia (PAB) in children is associated with considerable mortality despite at least four antipseudomonadal antibiotics has been introduced after 1990 [1]. Fortunately, PAB in children is rarely reported within last years, except of children with cystic fibrosis or cancer and neutropenia or critically ill post surgical or trauma children [2]. Within a 3 years nationalwide survey of Pseudomonas aeruginosa bacteremia in all major university hospitals in Slovakia (5.5 million inhabitants). Fourty three episodes within 169 patients of bacteremia appeared in fourty three children (25.4%). When comparing children (43 of 169 cases) 0– 18 years old (24.5%) to adults with Pseudomonas aeruginosa bacteremia, diabetes mellitus (p O 0.005 was the only risk factors Pseudomonas aeruginosa bacteremia seen significantly more frequently in adults than in children. Other risk factors, including antimicrobial susceptibility were similar. However a trend (30.2 vs. 16.6%, NS) towards higher death rate in children has been observed, despite the fact that more children than adults were appropriately treated (58.1 vs. 25.4%, p 6 0.001). Appropriate treatment (AT) was defined as resistant of antipseudomonal betalactam (piperacillin, ceftizidime, cefepine, cefoperazon/ subactam) in combination with aminoglycozide. Monotherapy with neuropenem vice versa mortality due to underlying disease with bacteremia was more common increase in adults (p < 0.009) (Table 1). In conclusion, there are no specific risk factors for PAB in children apart from adults. Attributable mortality is similar as well. Because of unacceptable mortality, in case of risk of Pseudomonas aeruginosa bacteremia mainly in children, venous catheter should be removed and initial therapy containing antipseudomonal betalac-