Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey

Abstract

Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.

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“…All statistical analyses were performed using the Intercooled Stata program, version 16, for Windows (Stata Corporation, College Station, Texas, USA). Description of statistical analysis was partially reported elsewhere 30 .…”

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“…The resistance rates of Escherichia coli and Klebsiella pneumoniae to quinolones were higher than those of nonfermentative bacteria, but the resistance rates to aminoglycosides were the opposite. Resistance to third generation cephalosporins by Enterobacteriaceae, which represents the major mechanism of antimicrobial resistance among Escherichia coli isolates 40 . Of the nonfermentative bacteria, Pseudomonas aeruginosa and Acinetobacter baumannii gradually exhibited resistance to carbapenems through an active e ux system and decreased permeability of the outer membrane [41][42] .…”

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