Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients:guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

Averbuch, Diana, Cordonnier, Catherine, Livermore, David M, Mikulska, Malgorzata, Orasch, Christina, Viscoli, Claudio, Gyssens, Inge C, Kern, Winfried V, Klyasova, Galina, Marchetti, Oscar, Engelhard, Dan, Akova, Murat and , ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN (2013) Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients:guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica, 98 (12). pp. 1836-47. ISSN 1592-8721

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Abstract

The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 20 Jan 2014 16:52
Last Modified: 23 Jan 2019 13:49
URI: https://ueaeprints.uea.ac.uk/id/eprint/46647
DOI: 10.3324/haematol.2013.091330

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