A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies.

Abstract

BACKGROUND:

Bloodstream infections (BSIs) caused by enterobacteria remain a leading cause of mortality in patients with chemotherapy-induced neutropenia. The rate and type of colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-E) and their mode of transmission in German cancer centres is largely unknown.

METHODS:

We performed a prospective, observational study at five German university-based haematology departments. Participating sites screened for intestinal ESBL-E colonization within 72 h of admission, every 10 ± 2 days thereafter and before discharge. Three of the five centres performed contact isolation for patients colonized or infected with ESBL-E. Molecular characterization of resistance mechanisms and epidemiological typing of isolates by repetitive extragenic palindromic PCR (rep-PCR) and PFGE was performed to assess strain transmission between patients.

RESULTS:

Between October 2011 and December 2012, 719 hospitalizations of 497 haematological high-risk patients comprising 20,143 patient-days were analysed. Mean duration of in-hospital stay was 36.6 days (range: 2-159 days). ESBL-E were identified from screening samples (82.8% Escherichia coli and 14.6% Klebsiella pneumoniae) in 55/497 patients (11.1%; range by centre: 5.8%-23.1%). PFGE and rep-PCR revealed only a single case of potential cross-transmission among two patients colonized with K. pneumoniae. Six episodes of BSI with ESBL-E were observed. Multivariate analysis revealed previous colonization with ESBL-E as the most important risk factor for BSI with ESBL-E (OR 52.00; 95% CI 5.71-473.89).

CONCLUSIONS:

Even though BSI with ESBL-E is still rare in this high-risk population, colonization rates are substantial and vary considerably between centres. In-hospital transmission of ESBL-E as assessed by molecular typing was the exception.

• Authors: Maria J G T Vehreschild, Axel Hamprecht, Lisa Peterson, Sören Schubert, Maik Häntschel, Silke Peter, Philippe Schafhausen, Holger Rohde, Marie V Lilienfeld-Toal, Isabelle Bekeredjian-Ding, Johannes Libam, Martin Hellmich, Jörg J Vehreschild, Oliver A Cornely, Harald Seifert
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 69 Issue 12 Pg. 3387-92 (Dec 2014) ISSN: 1460-2091 [Electronic] England
• PMID: 25103492 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• beta-Lactamases

Topics

• Adolescent
• Adult
• Aged
• Bacteremia (epidemiology, microbiology)
• Carrier State (epidemiology, microbiology)
• Cohort Studies
• Electrophoresis, Gel, Pulsed-Field
• Enterobacteriaceae (classification, enzymology, genetics, isolation & purification)
• Enterobacteriaceae Infections (epidemiology, microbiology)
• Female
• Genotype
• Germany (epidemiology)
• Hematologic Neoplasms (complications)
• Hospitals, University
• Humans
• Male
• Middle Aged
• Molecular Typing
• Polymerase Chain Reaction
• Prospective Studies
• Young Adult
• beta-Lactamases (classification, metabolism)