Associated factors and clinical outcomes of bloodstream infection due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae during febrile neutropenia.

Autor: Ben-Chetrit E; Department of Infectious Diseases, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel., Eldaim MA; Division of Internal Medicine D, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel., Bar-Meir M; Department of Infectious Diseases, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel., Dodin M; Department of Hematology-Oncology, Shaare-Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel., Katz DE; Division of Internal Medicine D, Shaare Zedek Medical Center, affiliated with Hebrew University, Jerusalem, Israel. Electronic address: dekatz1@gmail.com.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2019 Apr; Vol. 53 (4), pp. 423-428. Date of Electronic Publication: 2018 Dec 17.
DOI: 10.1016/j.ijantimicag.2018.12.003
Abstrakt: 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. 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 and 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 (ICU) admission. Univariate and multivariate models were constructed. The cohort (80 patients), consisted of 54 ESBL-negative and 26 ESBL-positive Gram-negative bacteremia. Multivariate analysis suggested ESBL-positive bacteremia to be associated with long-term central venous catheter (CVC) (odds ratio (OR), 8.7; 95% confidence interval (CI), 1.6-48.1; P=0.01], index culture obtained 48 h post-admission (OR, 3.6; 95% CI, 1-12.3; P=0.04), and exposure to previous antimicrobial therapy (OR, 12.6; 95% CI, 2.1-74; P<0.01). There were no significant differences between groups with regard to length of stay, ICU admission, or mortality rates. Mortality was associated with high Pitt bacteremia score but not inappropriate empirical therapy. 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.
(Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
Databáze: MEDLINE
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