Molecular Analysis and Risk Factors for Escherichia coli Producing Extended-Spectrum β-Lactamase Bloodstream Infection in Hematological Malignancies

Abstract

IntroductionPatients with hematologic malignancies have greater risk-factors for primary bloodstream infections (BSI).MethodsFrom 2004–2009, we analyzed bacteremia caused by extended-spectrum beta-lactamase Escherichia coli (ESBL-EC) (n = 100) and we compared with bacteremia caused by cephalosporin-susceptible E. coli (n = 100) in patients with hematologic malignancies.ObjectiveTo assess the clinical features, risk factors, and outcome of ESBL-EC BSI in patients with hematologic malignancies, and to study the molecular epidemiology of ESBL-EC isolates.ResultsThe main diagnosis was acute leukemia in 115 patients (57.5%). Death-related E. coli infection was significantly increased with ESBL-EC (34% vs. control group, 19%; p = 0.03). Treatment for BSI was considered appropriate in 64 patients with ESBL-EC (mean survival, 245±345 days), and in 45 control patients this was 443±613 (p = 0.03). In patients not receiving appropriate antimicrobial treatment, survival was significantly decreased in cases compared with controls (26±122 vs. 276±442; p = 0.001). Fifty six of the ESBL-EC isolates were characterized by molecular analysis: 47 (84%) expressed CTX-M-15, two (3.6%) SHV, and seven (12.5%) did not correspond to either of these two ESBL enzymes. No TLA-1 enzyme was detected.ConclusionsPatients who had been previously hospitalized and who received cephalosporins during the previous month, have an increased risk of ESBL-EC bacteremia. Mortality was significantly increased in patients with ESBL-EC BSI. A polyclonal trend was detected, which reflects non-cross transmission of multiresistant E.coli isolates.

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

“…This is consistent with a previous study that found an increased risk of bacteremia by ESBL-EC in patients colonized with ESBL-EC with a RR=4.5 (95 % CI 2.89-7.04) [1]. The higher risk to BSI by ESBL-EC of the same colonizing strain may be related with HM type; thus, therapy for primary disease: aggressive myelosuppressive chemotherapy; profound neutropenia, and the use of broad-spectrum antibiotics, consistent with previous findings [15,16,23,24]. It has been reported that acute myelogenous leukemia and prior treatment with platinum analogues or quinolones are independent risk factors for ESBL-EC BSI in colonized patients [25].…”

“…This phenomenon has been reported to occur in between 7 and 15 % in different settings, such as older patients with intestinal obstruction, chronic liver disease, or after abdominal surgery [20][21][22], but there have been scarce reports in patients with neutropenia. In a previous report on 63 (29 %) patients colonized with ESBL-EC of 217 patients with HM and neutropenia, only one developed BSI by ESBL-EC and eight by non-ESBL-EC [23]. We found 17 patients initially classified as colonized by non-ESBL-EC who switched during follow-up (mean days, 102 days) to an ESBL-EC strain.…”

“…In this study, patients colonized with ESBL-EC generated higher costs in all three categories analyzed. Antimicrobial resistance has been associated with higher health-related costs, longer length of hospital stay, and higher death rates [16,23]. Mortality increase is related to many risk factors such as greater severity of illness, a delay in administering an effective antibacterial therapy, and limitation of therapeutic interventions associated with higher risk of infections (chemotherapy, surgeries, or transplantation) [4,26,27].…”

Cepas E-ESKAPE multidrogorresistentes aisladas en hemocultivos de pacientes con cáncer

“…Aunado a lo anterior, el retraso en el inicio de antibióticos específicos puede también ser un factor relacionado con la mortalidad. 2 Las infecciones por microorganismos MDR incrementan la morbimortalidad, los días de estancia hospitalaria y los requerimientos en el uso de antibióti-cos de amplio espectro, asociados también con mayores costos de atención y otras complicaciones secundarias como colitis por Clostridum difficile.…”

The First Report of Extended-Spectrum β-Lactamase (ESBL) Genes in an Escherichia coli Isolate from a One-Month-Old Infant with Acute Lymphoblastic Leukemia (ALL) in Iran

“…Over the past few years, a remarkable increase has been reported in the number of ESBL-E. Coli-associated bloodstream infections in several parts of the world (13,14). Furthermore, in cancer patients with prolonged hospitalization and with ALL who had received antibiotics for a prolonged period, the opportunity for these bacteria to cause infections enhances (14).…”