A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies

Vehreschild, Maria J. G. T.; Hamprecht, Axel; Peterson, Lisa; Schubert, Sören; Häntschel, Maik; Peter, Silke; Schafhausen, Philippe; Rohde, Holger; Lilienfeld‐Toal, Marie von; Bekeredjian‐Ding, Isabelle; Libam, Johannes; Hellmich, Martin; Vehreschild, Jörg Janne; Cornely, Oliver A.; Seifert, Harald

doi:10.1093/jac/dku305

Cited by 94 publications

(76 citation statements)

References 21 publications

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“…Several studies reported risk factors for cephalosporin-resistant, ESBL-pro or MDR bacteria in cancer and HSCT patients [10,12,13,16,22,29,32]. Onl handful describe risk factors for carbapenem-resistant infections in popula involving but not limited to transplant patients, mainly for K. pneumoniae.…”

Section: Outcomementioning

confidence: 99%

“…studies, mainly limited to single centers or countries, describe rates and ris for specific resistant pathogens, such as extended-spectrum β-lactamase (E producing Enterobacteriaceae or multidrug-resistant (MDR) bacteria in pat with cancer and HSCT recipients [10][11][12][13]. The majority, however, were perfo countries with high resistance rates in both the hospitalized and general populations [12][13][14].…”

mentioning

confidence: 99%

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Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

Averbuch

Tridello

Hoek

et al. 2017

Clinical Infectious Diseases

211

119

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Section: Outcomementioning

confidence: 99%

mentioning

confidence: 99%

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

Averbuch

Tridello

Hoek

et al. 2017

Clinical Infectious Diseases

211

119

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“…55 The association between colonization and subsequent infection has been reported for many MDR bacteria, such as VRE, ESBL-producing Enterobacteriaceae, P. aeruginosa, S. maltophilia and carbapenem or colistin resistant K. pneumoniae. 115,116 Therefore, decolonization before the onset of neutropenia seems appealing in case of carbapenem-resistant bacteria, but very few data on the efficacy of this approach exist in this setting. For this purpose, oral gentamycin or a combination of oral gentamycin and colistin were used, with eradication rate of 40-50%, which was higher than the spontaneous eradication rate, but tended to decrease after few weeks.…”

Section: Othersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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“…[21][22][23][78][79][80][81][82][83][84][85][86][87][88][89][90] Most studies were conducted in the acute-care setting [21][22][23][79][80][81]83,85,87,[89][90][91] and identified a population of patients infected and/or colonized with MDR-E, either ESBL-E or CRE, or MDR-Enterobacteriaceae defined by resistance to multiple classes of drugs. Patients were assessed for persistence of colonization at study-specific intervals and variable durations of follow-up.…”

Section: Duration Of Colonizationmentioning

confidence: 99%

“…21,22 Studies also have described variability in detection of these bacteria from the gastrointestinal (GI) tract of the same individual over time (ie, positive culture followed by negative culture then reverting to positive). 21,23 Finally, certain extensively drug-resistant Enterobacteriaceae, particularly carbapenemase-producing bacteria, have no or limited treatment options, which makes the impact of even a single transmission event significant and provides the basis for a more conservative approach to duration of CP. …”

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confidence: 99%

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies

Abstract: Even though BSI with ESBL-E is still rare in this high-risk population, colonization rates are substantial and vary considerably between centres. In-hospital transmission of ESBL-E as assessed by molecular typing was the exception.

Cited by 94 publications

References 21 publications

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

Bloodstream infections in neutropenic cancer patients: A practical update

Duration of Contact Precautions for Acute-Care Settings

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