Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum β-lactamase production and its impact on outcome

Abstract

Escherichia coli and Klebsiella pneumoniae are main pathogens in neutropenic fever even if the proportion of Gram-positive cocci is increasing. Extended-spectrum β-lactamases (ESBL)-producing organisms are an emerging problem in nosocomial infection. Nevertheless, until now, information about risk factors for the acquisition and clinical outcomes of bacteremia due to ESBL-producing organisms is limited in neutropenic patients. From medical records collected between January 2007 and December 2008, we identified a total of 101 consecutive patients who developed bacteremia due to E. coli (n = 87) or K. pneumoniae (n = 14). Twenty-six (26 %) cases of bacteremia were caused by ESBL-producing organisms. A hospital stay of >2 weeks during the 3 months preceding bacteremia [adjusted odds ratio (OR), 5.887; 95 % confidence interval (CI), 1.572-22.041] and the use of broad-spectrum cephalosporins in the 4 weeks prior to bacteremia (adjusted OR, 6.186; 95 % CI, 1.616-23.683) were significantly related to the acquisition of ESBL. Twenty-four (92 %) of the ESBL-producing organisms were susceptible to either piperacillin-tazobactam or amikacin. Aminoglycosides (amikacin or isepamicin) were the main appropriate antimicrobial agents used against the ESBL-producing isolates during the initial empirical treatment (16/22, 73 %). However, the 30-day mortality rates for ESBL bacteremia and non-ESBL bacteremia were not significantly different (15 vs 5 %; p = 0.199). As alternatives to carbapenem, piperacillin-tazobactam plus amikacin or isepamicin combinations may be effective empirical therapeutic options for patients with neutropenic fever who are at high risk of developing bacteremia with ESBL-producing pathogens.

Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients

“…Epidemiological studies have shown it to be the second or third leading cause of bacteremia in such patients [23][24][25]. The reported risk of mortality from K. pneumoniae bacteremia is 18-30 %, and is even higher in patients infected with multidrug-resistant strains [25][26][27][28].…”

Bloodstream infections in neutropenic cancer patients: A practical update

“…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. 45,53 In consequence, in many countries, also cancer patients develop carbapenemresistant infections, as demonstrated by a retrospective survey performed in 52 transplant centers in Italy.…”

Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

“…loodstream infection (BSI) due to extended-spectrum-␤-lactamases (ESBLs) is increasingly being identified among patients with hematological malignancies (1)(2)(3)(4)(5). This is of special concern because a delay in initiating adequate antibiotic therapy may impair their outcomes (1,6).…”