Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies

Abstract

Fecal colonization by ESBL-EC is associated with increased risk of BSI by this strain, longer hospital stay, and higher related costs.

Bloodstream infections in neutropenic cancer patients: A practical update

“…94 Fecal colonization with resistant strains is related to an increased probability of BSIs caused by the same bacteria and the relative risk ranged from 3.4 to 4.5 for ESBL-producing E. coli. 95,96 Prophylaxis of bloodstream infection and fever during neutropenia Isolation of neutropenic patients in single rooms, observance of contact precautions and basic hygiene procedures are essential, but not sufficient, steps in infections prevention. Chemoprophylaxis is defined as administration of antibiotic agents to patients at risk for infectious complications but without any suggestive signs or symptoms, in order to prevent bacterial infection (Table 1).…”

The growing threat of multidrug-resistant Gram-negative infections in patients with hematologic malignancies

“…A multivariate analysis showed that ESBL-E colonization was the most important risk factor for ESBL-E BSI. Other investigators found that 22% of patients with hematologic malignancies who were colonized with ESBL-producing E. coli (ESBL-EC) developed subsequent ESBL-EC bacteremia [109]. A multicenter study of HSCT recipients in Italy also identified high rates of colonization to infection for CRKP.…”

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

“…80 Investigators in Mexico city evaluated the impact of fecal colonization with extended-spectrum b-lactamase-producing E coli for BSI, clinical outcome, and costs in patients with hematologic malignancies and severe neutropenia. 51 Colonization Treatment Challenges in the Immunocompromised Host with ESBL E coli increased the risk of BSI by the same strain (relative risk, 3.4; 95% CI, 1.5-7.8; P 5 .001), shorter time to death (74 AE 62 vs 95 AE 83 days; P < .001), longer hospital stay (64 AE 39 vs 48 AE 32 days; P 5 .01), and higher infection-related costs ($6528 AE $4348 vs $4722 AE $3173; P 5 .01). There was no difference in overall mortality between the groups.…”

“…In university hospitals in Italy, high rates of P aeruginosa BSIs (20% of all BSI) were observed in febrile neutropenic patients, with 33% to 70% MDR PSDA isolates reported. 61,62,65,66 Other centers have reported increasing rates of MDR A baumannii and other ESKAPE pathogens, 6,50,51,57,65 including carbapenem-resistant K pneumoniae (35%). 61 Garza-Ramos and colleagues 67 also described a high prevalence of ESBL and GES carbapenemases in carbapenem-resistant P aeruginosa in their hospitals.…”

“…Since that time, many authors throughout the world have reported on the shift to more resistant gram-negative bacteria, and the possible role of prophylactic fluoroquinolones in the selection of fluoroquinolone resistant bacteria, and ESBL producers, especially among Enterobacteriaceae (reviewed by 37,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] Because of this, Zhang and colleagues 63 looked at the issue of whether empiric oral fluoroquinolone is appropriate in low-risk neutropenic patients in China who presented with fever and BSI: 38 patients were studied and 74% had bloodstream isolates with E coli, with 46% resistance to fluoroquinolones. Other isolates included 2 K pneumoniae (1 resistant to fluoroquinolones).…”