Risk factors for bloodstream infections due to extended-spectrum β-lactamase producing Enterobacteriaceae in cancer patients

Abstract

Introduction: Bloodstream infection (BSI) caused by Enterobacteriaceae is associated with mortality in cancer patients receiving chemotherapy. The aim of this study is to identify the risk factors and outcomes related to BSIs caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in cancer patients.
 Methodology: Hematology/oncology patients, who were diagnosed with BSIs caused by Enterobacteriaceae by positive blood cultures were evaluated retrospectively. Patients were divided into two groups by ESBL-positive and ESBL-negative Enterobacteriaceae bacteremia. Patients' demographic features, underlying conditions, comorbidity, neutrophil count, duration of neutropenia, antibiotic use in the previous three months before infection, mechanical ventilation, steroid use, central venous catheter implementation, total parenteral nutrition (TPN), hospitalization in the past three months, stay in intensive care unit, quinolone prophylaxis, and history of infection with ESBL-producing Enterobactericeae were evaluated. Risk factors related to BSIs caused by ESBL-producing Enterobacteriaceae and mortality were assessed.
 Results: A total of 122 patients were evaluated retrospectively. Quinolone propyhlaxis, TPN, infection with Extended Spectrum Beta-Lactamase positive ESBL-P Enterobacteriaceae during the previous three months, treatment with piperasillin-tazobactam or carbapenems in the previous three months were found to be independent risk factors for ESBL-P BSIs. Longer duration of neutropenia before BSI and complication at the beginning of BSI were found to be independent risk factors for mortality related to infection.
 Conclusions: ESBL-producing Enterobacteriacea should be treated with an appropriate antibiotic that is associated with better outcomes in hematology/oncology patients with BSIs. History of broad-spectrum antibiotic use and stay in hospital in the previous three months should be taken into consideration upon commencing antibiotic therapy.

Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

“…reported that FN/ neutropenia was not the risk factor for mortality in BSIs caused by ESBL-PE among patients with malignancy. (14,16,21,24) Hence, the accuracy of the conclusion needs to be further confirmed. The combined RR of sensitivity analysis further confirmed the stability of the results.…”

“…(38,39) Interestingly, FN was not associated with higher mortality in oncological patients with BSIs caused by ESBL-PE, which could be attributed to there are only three studies included patients with FN, while some studies enrolled a subset of FN patients, but the data were not accessible to analysis. (13,14,16,21,24,25,30,34,40) Among these studies, Kang CI et al…”

“…In all the studies, the time of death records was not similar. The majority of studies used 30-day mortality to evaluate the clinical outcomes of BSIs caused by ESBL-PE in patients with malignancy, (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) only one study did not report a particular time of death. (30) The mortality varied from 10.7% to 31.0% in studies only enrolled oncological patients with ESBL-PE infections.…”

“…At the same time, indwelling urinary catheter,(23) pneumonia,(31) Pitt bacteremia score, (32) and severe sepsis/ septic shock (31) were the most common independent risk factors of mortality in studies that only enrolled patients with BSIs caused by ESBL-PE. In studies that both included ESBL-PE and non-ESBL-PE infections, severe sepsis/ septic shock, (14,16,18,19,22,24,28,33) ICU admission, (14,19,27,33,34) neutropenia, (13,14,24,35) and pneumonia (14,16,21,28) were the most commonly investigated independent risk factors, respectively. Interestingly, there were only three studies (13,14,16) identified that ESBL production was associated with unfavorable outcomes in these patients.…”

Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

“…At the same time, indwelling urinary catheter, (23) pneumonia, (31) Pitt bacteremia score, (32) and severe sepsis/ septic shock (31) were the most common independent risk factors of mortality in studies that only enrolled patients with BSIs caused by ESBL-PE. In studies that both included ESBL-PE and non-ESBL-PE infections, severe sepsis/ septic shock, (14,16,18,19,22,24,28,33) ICU admission, (14,19,27,33,34) neutropenia, (13,14,24,35) and pneumonia (14,16,21,28) were the most commonly investigated independent risk factors, respectively. Interestingly, there were only three studies (13,14,16) identi ed that ESBL production was associated with unfavorable outcomes in these patients.…”