Chemotherapy Alliance for Neutropenics and Control of Emerging Resistance (CANCER) Program: Initial Report from Haematology-Oncology Hospitals in North America (NA).

R.N. JONES1, 2, J. KIRBY1, A. MUTNICK1, M. BEACH1

Author address: 

1 The JONES Group/JMI Laboratories, N. Liberty, IA, 2 TUFTS Univ., Boston, MA

Abstract: 

Background: CANCER Program was founded (2001) to monitor resistance (R) in anti-microbial and -fungal therapies for cancer patients. Methods: 1,992 isolates from bloodstream (BSI) and other infections were isolated at 32 oncology centers, sent to a central laboratory and tested by NCCLS methods against 41 antimicrobials. Results: S. aureus (SA, n=361, 18.1%), E. coli (EC, 285, 14.3%), CoNS (282, 14.1%), Enterococcus spp (ESP, 197, 9.9%), and Klebsiella spp. (KSP, 191, 9.6%) were the top 5 pathogens during 2001. Vancomycin (VAN; MIC90, 1 µg/ml), linezolid (LZD; 2), quinupristin/dalfopristin (Q/D; 0.5), chloramphenicol (8) and rifampin ( 0.25) demonstrated no R in SA. For CoNS (MIC90), LZD (1), VAN (2), and Q/D (0.5) showed no R, while LZD (2) was completely active against ESP. Among agents tested against EC and KSP, carbapenems (MIC90, 0.25), cefepime ( 0.12) and amikacin (AMK; 2-4) provided 100% activity. For other cephalosporins and fluoroquinolones, S was: cefoxitin (92-95%), ceftazidime (98-99), ceftriaxone (98-100), ciprofloxacin (93-98) and gatifloxacin (92-98). Gentamicin (96-99% S; MIC90, 1) and tobramycin (TOB; 97-99;1) also provided high activity and the ESBL rate ranged from 2-5% in EC and KSP. Piper/tazo (P/T; MIC90, 4) had high S rates for EC (96%) and KSP (98%). AMK and TOB along with polymyxins were the only agents with S rates (94, 98, and 95%) higher then the best -lactam (P/T; 90%) against P. aeruginosa (PSA). Yeast BSI (50; 6 spp.) showed complete S to amphotericin, but 22% fluconazole-R (usually C. krusei or glabrata). Molecular studies detected a unique metallo- -lactamase in a PSA isolate (Texas). Conclusions: Elevated R rates were not observed in monitored CANCER centers during the baseline year of this novel, longitudinal surveillance program. BSI were the most frequent infection type (78% of isolates). Newer antifungals such as caspofungin have a wider spectrum than azoles.
2002

abstract No: 

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Full conference title: 

42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 42nd