Risk Factors and Scoring System for Predicting Bacterial Resistance to Cefepime as Used Empirically in Haematology Wards
Table 1
Baseline characteristics and clinical features at onset of the first episode of bacteraemia in the haematology ward.
Characteristic
All patients
Cefepime resistance
No cefepime resistance
Patient characteristics
Age, mean (SD), yr
53 (16)
51 (16)
54 (16)
0.32
Female, (%)
45 (43)
23 (46)
22 (42)
0.65
Primary diagnosis, (%)
Acute myeloid leukaemia and myelodysplastic syndrome
71 (68)
30 (60)
41 (77)
Acute lymphoblastic leukaemiab
13 (13)
11 (22)
2 (4)
0.005
Lymphoma or myeloma
13 (13)
5 (10)
8 (15)
Nonmalignant haematological disease
6 (6)
4 (8)
2 (4)
Phase of therapy, (%)
No chemotherapy in the previous 2 months
11 (11)
5 (10)
6 (11)
Inductionc
26 (25)
15 (30)
11 (21)
0.28
Relapse
20 (20)
9 (18)
11 (21)
Consolidation
21 (20)
8 (16)
13 (24)
Allogeneic Stem Cell Transplant
25 (24)
13 (26)
12 (23)
Graft-versus-host disease, (%)d
20 (80)
11 (85)
9 (75)
0.64
Comorbidities, (%)e
9 (9)
5 (10)
4 (8)
0.66
Risk factors in the month preceding bacteraemia
Transfer from abroad, (%)
6 (6)
4 (8)
2 (4)
0.43
Intensive care unit, (%)
3 (3)
3 (6)
0
0.11
Surgery, (%)
3 (3)
2 (4)
1 (2)
0.61
Antibiotic therapy with betalactams
25 (24)
18 (36)
7 (13)
0.007
Risk factors at the onset of bacteraemia
Neutrophil count, (%)
Neutrophils ≥500/mm3
27 (26)
13 (26)
14 (26)
0.56
Neutrophils 100–500/mm3
14 (14)
5 (10)
9 (17)
Neutrophils <100/mm3
62 (60)
32 (64)
30 (57)
Corticosteroid therapy, (%)
15 (15)
9 (18)
6 (11)
0.34
Another immunosuppressive therapy, (%)
23 (22)
13 (26)
10 (19)
0.39
Severe mucositis, (%)
8 (8)
6 (12)
2 (4)
0.15
Gut decontamination, (%)
76 (74)
39 (78)
37 (70)
0.35
Antibiotic therapy with β-lactams, (%)
21 (20)
17 (34)
4 (19)
0.001
Time elapsed since hospital admission, mean (SD), days
15 (13)
19 (15)
12 (10)
0.003
Central venous catheter, (%)
85 (83)
42 (84)
43 (81)
0.70
Time elapsed since central venous catheter insertion, mean (SD), daysf
17 (15)
20 (19)
14 (11)
0.040
Urinary catheter, (%)
1 (1)
1 (2)
0
0.49
Clinical features of bacteraemia
Fever, (%)
98 (95)
46 (92)
52 (98)
0.20
Severe sepsis, (%)
17 (17)
6 (12)
11 (21)
0.23
Shock, (%)
4 (4)
1 (2)
3 (6)
0.62
Unknown origin of bacteraemia, (%)
59 (58)
31 (62)
28 (53)
0.35
By chi-square test or Fisher’s exact test for qualitative variables; by Wilcoxon rank-sum test for skewed quantitative variables. bBy chi-square test comparing acute lymphoblastic leukaemia with other situations. cBy chi-square test comparing induction with other situations. dEstimates were computed for 25 patients with ASCT. e2 chronic obstructive pulmonary disease; 2 chronic heart disease; 2 cirrhosis; 2 diabetes mellitus; 1 diabetes mellitus and cirrhosis. fEstimates were computed for 85 patients with intravascular catheter.
