Journal
LEUKEMIA & LYMPHOMA
Volume 57, Issue 10, Pages 2245-2258Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/10428194.2016.1193859
Keywords
Gram-negative bacteria; Hematologic malignancies; Multidrug-resistant
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Funding
- NCATS NIH HHS [UL1 TR000457] Funding Source: Medline
- NIAID NIH HHS [K23 AI114994, T32 AI007613] Funding Source: Medline
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Prolonged neutropenia and chemotherapy-induced mucositis render patients with hematologic malignancies highly vulnerable to Gram-negative bacteremia. Unfortunately, multidrug-resistant (MDR) Gram-negative bacteria are increasingly encountered globally, and current guidelines for empirical antibiotic coverage in these patients may not adequately treat these bacteria. This expansion of resistance, coupled with traditional culturing techniques requiring 2-4 days for bacterial identification and antimicrobial susceptibility results, have grave implications for these immunocompromised hosts. This review characterizes the epidemiology, risk factors, resistance mechanisms, recommended treatments, and outcomes of the MDR Gram-negative bacteria that commonly cause infections in patients with hematologic malignancies. We also examine the infection prevention strategies in hematology patients, such as infection control practices, antimicrobial stewardship, and targeted decolonization. Finally, we assess the strategies to improve outcomes of the infected patients, including gastrointestinal screening to guide empirical antibiotic therapy, new rapid diagnostic tools for expeditious identification of MDR pathogens, and use of two new antimicrobial agents, ceftolozane/tazobactam and ceftazidime/avibactam.
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