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Associated factors and clinical outcomes of bloodstream infection due to extended-spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae during febrile neutropenia.
Int J Antimicrob Agents. 2018 Dec 17;:
Authors: Ben-Chetrit E, El Dahim MA, Bar-Meir M, Dodin M, Katz DE
Abstract
BACKGROUND: Patients with neutropenia are vulnerable to serious infections. During the last decade, increased prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae has affected immunocompromised patients. We conducted a single-center case-control study to evaluate factors associated with ESBL-positive bacteremia among neutropenic patients, and its clinical impact.
METHODS: The study included adult patients with hematologic or oncologic diseases diagnosed with ESBL-positive and ESBL-negative Escherichia coli or Klebsiella pneumoniae bacteremia during febrile neutropenia between January 2010 - October 2017 at the Shaare Zedek Medical Center, Jerusalem, Israel. Analyses included risk factors for ESBL-positive bacteremia, appropriateness of empiric antibiotics, mortality, length of stay, and intensive care unit admission. Univariate and multivariate models were constructed.
RESULTS: The cohort (80 patients), consisted of 54 ESBL-negative and 26 ESBL-positive Gram-negative bacteremias. Multivariate analysis suggested ESBL-positive bacteremia to be associated with long term CVC [odds ratio (OR), 8.7; 95% confidence interval (CI), 1.6 to 48.1; P=0.01], index culture obtained 48 hours post admission [OR, 3.6; 95% CI, 1 to 12.3; P=0.04], and exposure to previous antimicrobial therapy [OR, 12.6; 95% CI, 2.1 to 74; P<0.01]. There were no significant differences between groups with regards to length of stay, ICU admission, or mortality rates. Mortality was associated with high Pitt bacteremia score but not inappropriate empirical therapy.
CONCLUSION: Previous antimicrobial therapy, long-term CVC, and hospital-acquired bacteremia were associated with ESBL bacteremia. Neutropenic patients with ESBL bacteremia have increased morality due to other factors than ESBL status. These findings should be validated in other centers and with larger populations.
PMID: 30572008 [PubMed - as supplied by publisher]