Bacteraemia due to extended-spectrum  -lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome

Abstract

In our centre, ESBL-EC bacteraemia is frequent among cancer patients, especially in those exposed to antibiotic pressure. All ESBL-EC strains were unrelated and most of them carried a CTX-M group enzyme. Patients with ESBL-EC bacteraemia received inadequate empirical antibiotic therapy more frequently than patients carrying a susceptible strain, but significant differences in mortality could not be demonstrated.

Bloodstream infections in neutropenic cancer patients: A practical update

“…Extended-spectrum b-lactamase (ESBL) producing Enterobacteriaceae, which might not be covered by the standard empirical therapy with cephalosporins or piperacillin-tazobactam, are increasing in frequency in the neutropenic cancer patients 36,37,39,47,48 The percentage of ESBL-producing K. pneumoniae strains was over 50% in several series, while it was lower for E. coli, varying between 11% and 69% in different countries, even in pediatric patients. 37,[49][50][51] For example, ESBL-producing strains accounted for the 26% of all the E. coli and K. pneumoniae isolates in neutropenic patients in a South Korean study and for approximately 40% in Italian cohorts 36,43,49,52 Carbapenem-resistant gram-negative bacteria Carbapenem-resistance among GN bacteria is rising worldwide, different resistance mechanisms underlie non-susceptibility to this class of b-lactams, and K. pneumoniae, E. coli, P. aeruginosa and A. baumannii are the most affected species.…”

“…73,74 Patients with infections caused by resistant GN are less likely to receive an adequate empirical treatment, which in turn results in higher mortality rates, both in general population and in the setting of cancer patients. 48,52,75 Indeed, a prospective observational study carried out in Spain revealed higher mortality in neutropenic patients with BSIs due ESBL-producing Enterobacteriaceae who received an inadequate empirical treatment compared to those receiving appropriate therapy (37.5% vs. 6.5%). 48 High mortality rates were found for ESBL-producing E. coli (19%) and K. pneumoniae (29%) in cancer patients in Taiwan as well.…”

“…48,52,75 Indeed, a prospective observational study carried out in Spain revealed higher mortality in neutropenic patients with BSIs due ESBL-producing Enterobacteriaceae who received an inadequate empirical treatment compared to those receiving appropriate therapy (37.5% vs. 6.5%). 48 High mortality rates were found for ESBL-producing E. coli (19%) and K. pneumoniae (29%) in cancer patients in Taiwan as well. 76 Also in an Italian cohort of hematology patients, infections caused by ESBL-producing isolates were associated with an almost 9-fold increase in mortality.…”

ESBL-Producing Escherichia coli Isolated from Bloodstream Infections – Antimicrobial Susceptibility, Conjugative Transfer of Resistance Genes and Phylogenetic Origin

“…ESBL-producing Escherichia coli (ESBL-EC) is considered the causative agent of many severe and life-threading infections, such as meningitis and bloodstream infections (BSIs). The prevalence of BSIs caused by ESBL-EC has increased dramatically over the past few years [6][7][8]. Moreover, hospital-acquired BSIs are frequently associated with many adverse outcomes, including increased rates of treatment failure, prolonged hospital stays, increased morbidity and mortality, and higher economic costs [9,10].…”

The emerging problem of bacterial resistance in cancer patients; proceedings of a workshop held by MASCC “Neutropenia, Infection and Myelosuppression” Study Group during the MASCC annual meeting held in Berlin on 27–29 June 2013

“…In a study from South Korea, ESBL-associated bacteremia was identified as an independent risk for mortality in patients with hematologic malignancies and associated with a 30-day mortality of almost 45 % [28]. Although many ESBLs produced by E. coli are inhibited by β-lactamase inhibitors such as tazobactam, piperacillin is not consistently active and carbapenems remain the treatment of choice for ESBL-related infections; delay of early adequate antibiotic therapy still correlates with increased mortality outcomes [25,[29][30][31]. Unfortunately, frequent co-carriage of other antibiotic resistance genes on ESBL-expressing plasmids has led to increasing multidrug resistance including the fluoroquinolones [32].…”