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Director/Pharmacology, The JONES Group/JMI Laboratories, North Liberty, IA; Adjunct Associate Professor, College of Pharmacy, University of Iowa, Iowa City, IA
Study Coordinator, The JONES Group/JMI Laboratories
Director, The JONES Group/JMI Laboratories; Adjunct Professor of Medicine, School of Medicine, Tufts University, Boston, MA
Reprints: Alan H Mutnick PharmD, The JONES Group/JMI Laboratories, 345 Beaver Kreek Centre, Ste. A, North Liberty, IA 52317-9258, FAX 319/665-3371, E-mail alan-mutnick{at}jmilabs.com
OBJECTIVE: The CANCER (Chemotherapy Alliance for Neutropenics and the Control of Emerging Resistance) surveillance program was initiated to collect culture data on antimicrobial and antifungal agents in hospitals treating neutropenic patients in North America, as a means to monitor the development of microbial resistance.
METHODS: A total of 2042 isolates from bloodstream, respiratory, urinary, and cutaneous infections in 2000–2001 were submitted by 33 oncology centers, clinics, and hospitals in North America, sent to a central laboratory, and tested by National Committee for Clinical Laboratory Standards methods against 42 different antimicrobials.
RESULTS: Staphylococcus aureus, Escherichia coli, coagulase-negative staphylococci, Enterococcus spp., and Klebsiella spp. represented the most frequently isolated pathogens during the initial benchmark year. The incidence of extended-spectrum ß-lactamase–producing phenotypes ranged from 1.6% to 4.6% among E. coli and Klebsiella spp. Amikacin, tobramycin, polymyxin B, and piperacillin/tazobactam provided the highest susceptibility rates against Pseudomonas aeruginosa isolates. Yeast bloodstream isolates demonstrated complete susceptibility to amphotericin B, but 14% of strains were considered to have high-level fluconazole resistance.
CONCLUSIONS: Elevated resistance rates when compared to general hospital strains were not observed in the CANCER program during the baseline year of this novel longitudinal, resistance surveillance program. The prevalence of gram-positive pathogens, although representing more than 50% of all bacterial isolates, was slightly lower than that reported previously by other investigators. Continued evaluation for antimicrobial resistance as well as changes in the prevalence of gram-positive pathogens requires the use of longitudinal surveillance programs such as the CANCER program. Such initiatives allow the development of therapeutic strategies for coping with changes in resistance and pathogen prevalence in this dynamic at-risk patient environment.
Key Words: antimicrobial resistance, neutropenia, surveillance
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