Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies

• Published in: Infection 2012-12, Vol.40 (6), p.613-619
• Main Authors: Liss, B. J., Vehreschild, J. J., Cornely, O. A., Hallek, M., Fätkenheuer, G., Wisplinghoff, H., Seifert, H., Vehreschild, M. J. G. T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Bacteremia - drug therapy; Bacteremia - microbiology; beta-Lactamases - metabolism; Blood; Blood culture; Clinical and Epidemiological Study; Cohort Studies; Colonization; Cross Infection - complications; Cross Infection - epidemiology; Data processing; Enterobacteriaceae; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - microbiology; Family Medicine; Feces; Feces - microbiology; Female; Fever; Gastrointestinal Tract - microbiology; General Practice; Germany; Hematology; Humans; Infection; Infectious Diseases; Internal Medicine; Intestine; Leukemia; Logistic Models; Male; Malignancy; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neoplasms - complications; Neutropenia; Oncology; Platinum; Prospective Studies; Quinolones; Regression analysis; Risk Factors; Vancomycin - therapeutic use; Vancomycin Resistance; Young Adult
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-012-0269-y

Background In patients with haematological or oncological malignancies, we aimed to assess the rate of intestinal colonisation and blood stream infections (BSI) with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) and vancomycin-resistant enterococci (VRE), mortality and risk factors associated with ESBLE/VRE BSI, as well as the impact of faecal screening for ESBLE and VRE in combination with adapted empiric treatment of febrile neutropenia. Methods Within 72 h of admission to our department, an ESBLE and VRE screening stool sample was collected. In the case of neutropenic fever, blood cultures were drawn. Data of all admitted patients were prospectively documented. Explorative forward-stepwise logistic regression analyses were used to identify risk factors for progression from intestinal colonisation to BSI. Results During the study period, 1,805 stool samples were obtained from 513 patients during 1,012 inpatient stays, and 2,766 blood cultures were obtained from 578 patients during 1,091 inpatient stays. Ninety (17.5 %) of these patients were colonised with ESBLE and 51 (9.9 %) with VRE. Proportions of 40 % (36/90) of ESBLE and 61 % (31/51) of VRE colonisations were healthcare-associated. Six of 90 (6.6 %) ESBLE-colonised patients and 1/51 (2 %) VRE-colonised patients developed BSI with the respective organism. None of these patients died after receiving early appropriate empiric antibiotics based on colonisation status. Colonisation with ESBLE or VRE was associated with increased risk ratios (RR) towards developing ESBLE BSI [RR 4.5, 95 % confidence interval (CI): 2.89–7.04] and VRE BSI (RR 10.2, 95 % CI: 7.87–13.32), respectively. Acute myelogenous leukaemia and prior treatment with platinum analogues or quinolones were identified as independent risk factors for ESBLE BSI in colonised patients. Conclusions Intestinal ESBLE/VRE colonisation predicts BSI. Faecal screening in haematology/oncology patients in combination with directed empiric treatment may reduce ESBLE BSI-related mortality.