Molecular analysis and risk factors for Escherichia coli producing extended-spectrum β-lactamase bloodstream infection in hematological malignancies

• Published in: PloS one 2012-04, Vol.7 (4), p.e35780-e35780
• Main Authors: Cornejo-Juárez, Patricia, Pérez-Jiménez, Carolina, Silva-Sánchez, Jesús, Velázquez-Acosta, Consuelo, González-Lara, Fernanda, Reyna-Flores, Fernando, Sánchez-Pérez, Alejandro, Volkow-Fernández, Patricia
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Automation; Bacteremia; beta-Lactamases - biosynthesis; beta-Lactamases - genetics; Biology; Blood cancer; Cephalosporins; Chemotherapy; Clinical outcomes; Deoxyribonucleic acid; DNA; E coli; Enterobacteriaceae; Epidemiology; Escherichia coli; Escherichia coli - enzymology; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Escherichia coli Infections - mortality; Female; Health risks; Hematology; Hospitalization; Hospitals; Humans; Infections; Infectious diseases; Kaplan-Meier Estimate; Klebsiella pneumoniae; Leukemia; Leukemia - complications; Leukemia - diagnosis; Male; Medicine; Microorganisms; Middle Aged; Mortality; Neutropenia; Patients; Plasmids; Risk analysis; Risk Factors; Sepsis; Survival; β Lactamase
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0035780

Patients with hematologic malignancies have greater risk-factors for primary bloodstream infections (BSI). From 2004-2009, we analyzed bacteremia caused by extended-spectrum beta-lactamase Escherichia coli (ESBL-EC) (n = 100) and we compared with bacteremia caused by cephalosporin-susceptible E. coli (n = 100) in patients with hematologic malignancies. To assess the clinical features, risk factors, and outcome of ESBL-EC BSI in patients with hematologic malignancies, and to study the molecular epidemiology of ESBL-EC isolates. The main diagnosis was acute leukemia in 115 patients (57.5%). Death-related E. coli infection was significantly increased with ESBL-EC (34% vs. control group, 19%; p = 0.03). Treatment for BSI was considered appropriate in 64 patients with ESBL-EC (mean survival, 245 ± 345 days), and in 45 control patients this was 443 ± 613 (p = 0.03). In patients not receiving appropriate antimicrobial treatment, survival was significantly decreased in cases compared with controls (26 ± 122 vs. 276 ± 442; p = 0.001). Fifty six of the ESBL-EC isolates were characterized by molecular analysis: 47 (84%) expressed CTX-M-15, two (3.6%) SHV, and seven (12.5%) did not correspond to either of these two ESBL enzymes. No TLA-1 enzyme was detected. Patients who had been previously hospitalized and who received cephalosporins during the previous month, have an increased risk of ESBL-EC bacteremia. Mortality was significantly increased in patients with ESBL-EC BSI. A polyclonal trend was detected, which reflects non-cross transmission of multiresistant E.coli isolates.