Multidrug-resistant Escherichia coli bacteremia in cancer patients

• Published in: American journal of infection control 2009-11, Vol.37 (9), p.741-745
• Main Authors: Vigil, Karen J., MD, Adachi, Javier A., MD, Aboufaycal, Halim, MD, Hachem, Ray Y., MD, Reitzel, Ruth A., BS, Jiang, Ying, MS, Tarrand, Jeffrey J., MD, Chemaly, Roy F., MD, Bodey, Gerald P., MD, Rolston, Kenneth V., MD, Raad, Isaam, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - pharmacology; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial Typing Techniques; Cancer; Case-Control Studies; Chemotherapy; Cluster Analysis; Cross Infection - epidemiology; Cross Infection - microbiology; Deoxyribonucleic acid; Disease control; Disease transmission; DNA; DNA Fingerprinting; Drug resistance; Drug Resistance, Multiple, Bacterial; E coli; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Escherichia coli Infections - epidemiology; Escherichia coli Infections - microbiology; Female; Genotype; Humans; Infection Control; Infectious Disease; Male; Middle Aged; Molecular Epidemiology; Neoplasms - complications; Polymerase chain reaction; Risk Factors
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.02.002

Background Multidrug-resistant (MDR) Escherichia coli is a serious threat to cancer patients. We aimed to determine the risk factors associated with the development of MDR E coli bacteremia in cancer patients and the possibility of horizontal transmission. Methods We conducted a 1:2 case-control study of 58 patients with MDR E coli bacteremia. The patient's demographics, clinical characteristics, and antibiotic use were obtained. MDR E coli was defined as resistant strains to quinolones plus 1 of the following: piperacillin, ceftazidime, or cefepime. Repetitive sequence-based polymerase chain reaction (Rep-PCR) was used to identify DNA interstrain similarities. Results Conditional multiple logistic analysis showed that admission to the hospital within the 30 days prior to infection and chemotherapy use were risk factors for infection with MDR E coli . Rep-PCR showed that, among the MDR E coli strains recovered, 48.6% showed >95% similarity, representing a possible clonal outbreak. Infection control measures were implemented and controlled this horizontal transmission. Conclusion Prior admission to the hospital and previous chemotherapy were independent risk factors of acquiring MDR E coli . Molecular fingerprinting techniques detected a possible nosocomial clonal outbreak of MDR E coli , which was aborted through infection control measures.