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New Information About Antimicrobial Resistance in Oncology Units

ATLANTA -- Antimicrobial-resistant E. coli and E. faecium have become significant pathogens in oncology units in hospitals, according to a recent report.

The article published recently in the journal Clinical Infectious Diseases describes central line-associated bloodstream infection (CLABSI) pathogens and antimicrobial resistance patterns found in oncology locations and reported to the CDC’s National Healthcare Safety Network (NHSN).

The CDC emphasizes that recent antimicrobial resistance data have been lacking from inpatient oncology settings, making it difficult to guide infection prophylaxis and develop treatment recommendations.

Public health officials note that the recent analysis represents the largest set of data from the United States on pathogens and antimicrobial resistance in hospital oncology treatment areas and is the first nationwide evaluation of pathogen patterns and antimicrobial trends among bloodstream infections from a hospitalized oncology patient population in more than a decade.

CDC researchers used CLABSI data reported to NHSN from 2009 to 2012 from adult inpatient oncology locations and compared it to data from non-oncology locations within the same hospitals, calculating pathogen profile, antimicrobial resistance rates, and CLABSI incidence rates per 1,000 central line days.

Results indicate that, from 2009–2012, 4,654 CLABSIs were reported to NHSN from 299 adult oncology units. The most common organisms causing CLABSI in oncology locations were coagulase-negative staphylococci (16.9%), Escherichia coli (11.8%), and Enterococcus faecium (11.4%).

The study also finds that fluoroquinolone resistance was more common among E. coli CLABSI in oncology than non-oncology locations (56.5% vs 41.5% of isolates tested) and increased significantly from 2009–2010 to 2011–2012 (49.5% vs 60.4%).

In addition, rates of CLABSI were significantly higher in oncology compared to non-oncology locations for fluoroquinolone-resistant E. coli (rate ratio, 7.37) and vancomycin-resistant E. faecium (rate ratio, 2.27).

Resistance rates for some organisms, such as Klebsiella species and Pseudomonas aeruginosa, were lower, however, in oncology than in non-oncology locations, the report points out.

“Practices for antimicrobial prophylaxis and empiric antimicrobial therapy should be regularly assessed in conjunction with contemporary antimicrobial resistance data,” study authors concluded.

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