Bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a systematic review and meta-analysis

• Published in: International journal of antimicrobial agents 2017-11, Vol.50 (5), p.657-663
• Main Authors: Alevizakos, Michail, Gaitanidis, Apostolos, Andreatos, Nikolaos, Arunachalam, Karuppiah, Flokas, Myrto Eleni, Mylonakis, Eleftherios
• Format: Article
• Language: English
• Subjects: beta-Lactamases - secretion; Bloodstream infection; Cancer; Enterobacteriaceae - enzymology; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; ESBL; Extended-spectrum β-lactamase; Global Health; Humans; Malignancy; Meta-analysis; Neoplasms - complications; Prevalence; Sepsis - epidemiology; Sepsis - microbiology; Spatio-Temporal Analysis
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2017.07.003

•Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are a major cause of hospital infections.•Among patients with malignancy, 1 in 10 bloodstream infections is caused by ESBL-PE.•The incidence can be as high as 1 in 3 in areas such as Southeast Asia.•Importantly, the incidence of these resistant infections is rising. Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are an increasing cause of resistant infections among patients with malignancy. This study sought to estimate the prevalence of bloodstream infections (BSIs) caused by ESBL-PE in this population and to examine regional and temporal differences. The PubMed and EMBASE databases (to 30 April 2016) were searched to identify studies reporting ESBL-PE BSI rates among patients with malignancies. Of 593 non-duplicate reports, 22 studies providing data on 5650 BSI cases satisfied the inclusion criteria. Among all BSIs the pooled prevalence of ESBL-PE was 11% (95% CI 8–15%) and among Gram-negative BSIs it was 21% (95% CI 16–27%). Among patients with haematological malignancies, the pooled ESBL-PE prevalence was 11% (95% CI 8–15%), whereas no studies providing specific data on patients with solid tumours were identified. Stratifying per geographic region, the pooled prevalence was 7% each in Europe (95% CI 5–11%), the Eastern Mediterranean region (95% CI 4–11%) and South America (95% CI 2–14%), 10% in the Western Pacific region (95% CI 4–19%) and 30% in Southeast Asia (95% CI 18–44%). Importantly, there was a 7.1% annual increase in the ESBL-PE incidence (P = 0.004). Overall, ca. 1 in 10 BSIs in patients with malignancy is caused by ESBL-PE and in some areas this rate can be as high as 1 in 3 cases. Additionally, the incidence of these resistant infections is rising. These findings should be considered when selecting empirical antimicrobial therapy and should prompt strict adherence to antimicrobial stewardship.