BACTEREMIA DUE TO MULTIRESISTANT GRAM-NEGATIVE BACILLI IN NEUTROPENICCANCER-PATIENTS - A CASE-CONTROLLED STUDY

The aim of this study was to see if multiresistant Gram-negative bacte remias (MRGNB) are associated with specific risk factors and/or higher mortality in comparison to sensitive GNB (SGNB). Both groups, 51 pati ents and 102 controls, were matched for sex, age, underlying disease a nd neutropenia. In addition there were no significant differences in t he incidence of cytotoxic chemotherapy administered, vascular catheter insertion and catheter as source of bacteremia and etiology of bacter emia. The proportion of Klebsiella-Enterobacter, Pseudomonas aeruginos a, Acinetobacter spp. and Stenotrophomonas maltophilia was similar in both groups. Prior surgery (21.6% vs 7.6%, p<0.02) was significantly a ssociated with SGNB. Previous prophylaxis with quinolones (45.1% vs 24 .5%, p<0.045), and prior therapy with broad spectrum antibiotics (41.2 % vs 27.5%, p<0.05) were significantly more frequently observed among patients than controls. Patients with bacteremia due to MRGNB were als o significantly more frequently infected with resistant bacteria. Attr ibutable mortality was similar (15.7% vs 13.75%, NS) in both groups, h owever cure rates were lower among MRGNB patients. Crude mortality was higher among patients (35.3% vs 13.75%, p<0.01) in comparison to cont rols. In conclusion, prior antimicrobial prophylaxis and therapy with several classes of antimicrobials represents a significant risk for de velopment of resistance. Mortality due to multiresistant Gram-negative ; bacteremias was higher in comparison to bacteremias due to susceptib le organisms.