Keypoints that discussed: prevalance at out Hospital, sources of infection, prophylactic measures.  Risk-adapted strategy according to identifying those patients at higher risk for MDR GNB infectiona dn previous history of colonization. The value of surveillance studies. How to approach MDR GNB infections in neutropenic patients?

We adapted following policy:

As per our policy, we evaluate previous micorbiological history for all patients entering the BMT Unit and documet it in the "BMT report" letter. We perform VRE and MRSA screening.

Patients with previous bloodstream infection due to MDR GNB or known to be colonized by MDR GNB should receive an empiric antibiotic regimen with in vitro activity against the MDR Gram-negative pathogen.

The antibiotic regimen should be changed to a standard empiric regimen within 48–72 h if the patient is stable and blood cultures are negative for MDR GNB.

Other important keypoints

Antibiotic resistance in neutropenic patients may develop either by horizontal transmission of resistant bacteria or most typically by selective pressure exerted by broad-spectrum antimicrobial agents given as prophylaxis or therapy.

The majority of Gram-negative bacterial infections are caused by Enterobacteriaceae (especially E. coli and Klebsiella spp.) and Pseudomonas aeruginosa

Patients more likely to develop MDR Gram-negative BSI are those expected to have profound and prolonged neutropenia, especially if they are in ICU and are submitted to multiple invasive procedures.

Surveillance cultures may be of help for their negative predictive value and are more likely to be cost-effective in centers with higher incidences of Gram-negative BSI.

Preventive strategies include hand hygiene, active screening, contact precautions, geographic and personnel cohorting and the judicioususe of antibiotics by the implementation of stewardship programs.

Lecturer: Prof. Marangos

Participants: all medical staff