Abstract Topic: 30. Infections in hematology (incl. supportive care/therapy)
Background: Antimicrobial resistance (AMR) which is a serious health problem worldwide is of particular importance in hematology.
Patients receiving intensive chemotherapy have an increased risk of febrile episodes due to the development of neutropenia. The COVID-19 pandemic has exacerbated the problem of AMR, which was largely caused by the improper use of antibiotics.
Monitoring of antibiotic resistance and its consequences in the post COVID period is crucial for assessing and optimizing infectious safety in hematology hospitals.
Aims:
The aim of the study was to study the dynamics of antibiotic-resistant strains and the outcomes of therapy in patients with bloodstream infections in the post COVID period.
Methods: A retrospective analysis of the structure and antibiotic resistance of 91 pathogens obtained from the blood of 67 patients being treated at the hematology center of Karaganda in the period from 2021 to 2022 was carried out. The average age of patients was 57.47 years±15.9 years, patients with acute leukemia prevailed - 29 people, 72.4% of them with AML; chronic lymphoproliferative diseases - 20, 50% of them with multiple myeloma, MDS-7, CMP-3, blood diseases - 8 people.
The total number of episodes of febrile fever is 91, of which febrile neutropenia is in 46 cases. Bacteriological examination was carried out with identification by time-of-flight mass spectrometry, determination of antimicrobial sensitivity was carried out in accordance with the recommendations of CLSI M100-24.
The structure of the 1st line of antibacterial therapy and its effectiveness were analyzed. The outcomes were cases of positive treatment of febrile fever, deaths within 28 days, the need for 2 or more courses of antibacterial therapy. Statistical analysis was carried out using SPSS version 23.0.
Results: Analysis of the structure of pathogens that were isolated from the blood showed that in 2022 the proportion of gram-negative bacteria increased from 26.9% to 47.7%. The incidence of Escherichia coli decreased from 57.1% to 16.1% due to the appearance of non-fermenting microorganisms in the etiological structure of blood diseases, such as Pseudomonas aeruginosa (22.6%), Stenotrophomonas maltophilia (9.67%), the incidence of Klebsiella pneumoniae remained unchanged at 28.5-32.2%.
The prevalence of the specific gravity of staphylococci remained - 83.3-83.8%, the level of MRSA positive staphylococci was 0-13.3%. The analysis showed an increase in antibiotic-resistant forms among gram-negative bacteria from 0% in 2021 to 53.1% in 2022: of these, 34.4% are ESBL-resistant forms, 15.6% are CRK/4MRGN and 3.12% are CRK. In the structure of line 1 antibacterial therapy in 2021, ceftazidime and piperacillin tazobactam occupied the same proportion - 44.4% each, in 2022 - the appointment of piperacillin tazobactam increased to 76.6%.
The frequency of achieving a positive effect of therapy in 2021 and 2022 did not differ - 66.7% and 64.0%, respectively (χ2=1.28; p=0.258), however, the frequency of prescribing 2 or more courses of antibacterial therapy in 2022 was significantly higher compared to 2021 - 62.5% and 25.9% ((χ2=10.45; p=0.002).
Summary/Conclusion: The growth of antibiotic-resistant gram-negative non-fermenting strains in hematological hospitals is accompanied by a deterioration in the results of line 1 therapy, additional consumption of broad-spectrum antibacterial drugs. There is an increasing need to monitor the causes of infection and establish their own empirical protocols of antibacterial therapy to achieve the best results in the treatment of febrile neutropenia.
Keywords: Multidrug resistance, Febrile neutropenia, Infection