Fecal ESBL Escherichia Coli Carriage As a Risk Factor for Bacteremia in Patients with Hematological Malignancies

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2015 May 28

PMID 26014616

Citations 33

Authors

Patricia Cornejo-Juarez

Juan Antonio Suarez-Cuenca

Patricia Volkow-Fernandez

Jesus Silva-Sanchez

Humberto Barrios-Camacho

Esmeralda Najera-Leon

Consuelo Velazquez-Acosta

Diana Vilar-Compte

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study is to evaluate the impact of fecal extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) colonization for bloodstream infection (BSI), clinical outcome, and costs in patients with hematologic malignancies (HM) and severe neutropenia.

Methods: This is a cohort study, carried out at a cancer-referral hospital. The study population comprises patients with HM, hospitalized prior to administration of the first chemotherapy cycle. A stool culture was taken during the first 48 h; they were grouped as colonized by ESBL-EC or non-ESBL-EC. Patients were followed upon completion of chemotherapy or death. The sum of the days of antibiotics and the length of stay of all hospitalizations in the different cycles of chemotherapy were recorded.

Results: We included 126 patients with a recent diagnosis of HM, grouped as 63 patients colonized by ESBL-EC and 63 colonized by non-ESBL-EC, aged 42 ± 16 years old, 78 males (62%). BSI by ESBL-EC developed in 14 patients (22.2%) colonized by the same strain and in 5 (7.9%) in the group colonized with non-ESBL-EC. BSI by non-ESBL-EC was observed in 3 patients (4.7%) colonized by ESBL-EC and in 17 (26.9%) patients colonized by non-ESBL-EC. Colonization with ESBL-EC increased the risk of BSI by the same strain (relative risk (RR) = 3.4, 95% confidence interval (95% CI) 1.5-7.8, p = 0.001), shorter time to death (74 ± 62 vs. 95 ± 83 days, p < 0.001), longer hospital stay (64 ± 39 vs. 48 ± 32 days, p = 0.01), and higher infection-related costs ($6528 ± $4348 vs. $4722 ± $3173, p = 0.01). There was no difference in overall mortality between both groups.

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

Citing Articles

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Fecal Carriage of Extended-Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia: A Comparative Cross-Sectional Study.

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de la Court J, Woudt S, Schoffelen A, Heijmans J, de Jonge N, van der Bruggen T Ann Clin Microbiol Antimicrob. 2022; 21(1):54.

PMID: 36443758 PMC: 9707019. DOI: 10.1186/s12941-022-00544-0.

The Dutch Working Party on Antibiotic Policy (SWAB) Recommendations for the Diagnosis and Management of Febrile Neutropenia in Patients with Cancer.

de la Court J, Bruns A, Roukens A, Baas I, van Steeg K, Toren-Wielema M Infect Dis Ther. 2022; 11(6):2063-2098.

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