Antimicrobial resistance patterns, clinical features, and risk factors for septic shock and death of nosocomial E coli bacteremia in adult patients with hematological disease

Abstract

The aim of this retrospective analysis was to evaluate the antimicrobial resistance, clinical features, and risk factors for septic shock and death of nosocomial E coli bacteremia in adult patients in a single hematological center in China. A retrospective case-control study of 157 adult hematological patients with 168 episodes of E coli bacteremia was initiated from April 2012 to July 2015. Antimicrobial susceptibility as well as antimicrobial co-resistance rates were analyzed. Clinical features and outcomes were also studied. In addition, risk factors for septic shock and death were investigated. Among the 553 positive blood isolates during the study period, the prevalence of E coli was 33.3% and ESBL production strains represented 61.9% of those examined. In all the E coli strains isolated, 85.6% were multidrug-resistance (MDR), 2.4% were extensive drug resistance (XDR), and 6.0% were resistant to carbapenems. More MDR phenotype was noted in ESBL-EC strains (98.6% vs 62.8%, P<.001) and isolates from neutropenic patients (98.6% vs 62.8%, P < .001). In the antimicrobial susceptibility test, carbapenems and amikacin exhibited not only higher in vitro activity against E coli (94.0% and 92.0%, respectively), but lower co-resistance rates to other antibiotics. Carbapenem resistant strains retained full sensitivity to tigecycline and 60% to amikacin. Piperacillin/tazobatam was the third sensitive drug to both ESBL-EC (77.1%) and non-ESBL-EC (86.0%). In our series, 81.6% episodes received appropriate initial antibiotic treatment and no significant decrease in it was found in bacteremia due to ESBL E coli and patients with neutropenia, septic shock. Septic shock was noted in 15.5% patients and the overall 30-day mortality rate was 21.7%. Multivariate analysis revealed that induction chemotherapy (OR 2.126; 95% CI 1.624–11.332; P = .003) and polymicrobial infection (OR 3.628; 95% CI 1.065–21.219; P = .041) were risk factors for septic shock, whereas male (OR 2.223; 95% CI 1.132–12.022; P < .01) and septic shock (OR 52.359; 95% CI 19.951–292.690; P = .030) were risk factors for death.In the hematology department, ESBL-producing and MDR are widely prevalent in E coli bacteremia which is still a major life-threatening problem, especially for patients with septic shock. For empirical antimicrobial therapy, combination based on aminoglycoside, especially amikacin, will be helpful to increase the antimicrobial coverage against ESBL-EC while combining tigecycline with aminoglycoside should be considered for seriously carbapenem-resistant infectious patients.

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

“…Different studies have also proven that inappropriate empirical therapy is a risk factor for death rather than MDR infection. The high rate of appropriate empirical therapy explained why shock and MDR infection were not associated with mortality in our study [19]. However, the susceptibility rate for amikacin was 91.1%.…”

Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study

“…Furthermore, some studies have reported the emergence of broad-spectrum antibiotic-resistant bacteria, including multidrug-resistant Pseudomonas aeruginosa (MDRP) and Acinetobacter spp. (MDRA), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRP), third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumonia, and methicillin-resistant Staphylococcus aureus (MRSA) [6][7][8][9]. These antibiotic-resistant strains have become a significant threat to cancer patients [9][10][11][12].…”

Prevalence of blaCTX-M, blaSHV and blaTEM β-Lactamase Genes Among Escherichia coli Isolates in Foodborne Outbreak in Iran

“…16 We focused on bla CTX-M , bla SHV and bla TEM genes which are recognized to exhibit resistance to β-lactam antibiotics and are a major public health issue worldwide. 17 The use of broad-spectrum beta-lactam antibiotics has increased rapidly along with resistance to these antibiotics. 18 Currently, there are several phenotypic tests recommended by the CLSI to detect ESBLs.…”