Abstract
Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.
Highlights
Several advances have been made in clinical management of patients with haematological malignancies (HM), bloodstream infections (BSIs) remain life-threatening complications in the clinical course of these patients, with reported crude mortality rate up to 40% [1,2,3,4,5,6]
In the present study conducted in 15 Italian Haematological Units we found that the rate of resistance to 3GC among Escherichia coli (EC) isolates was 25.7% (88/342)
Resistance to 3GC among EC isolates was slightly lower than that reported in Italian general population during the same period (2016 to 2017) by Antimicrobial Resistance Surveillance in Europe (EARSS) (25.7% vs. 29.6%) [14] and it was substantially in line with reports conducted in HM or cancer patients in other countries [9,15,16,17]
Summary
Several advances have been made in clinical management of patients with haematological malignancies (HM), bloodstream infections (BSIs) remain life-threatening complications in the clinical course of these patients, with reported crude mortality rate up to 40% [1,2,3,4,5,6]. A clear shift of bacterial species causing BSI in HM patients has been reported during the last decade from Gram-positives to Gram-negatives, and among the latter, Enterobacteriaceae, and in particular Escherichia coli (EC), represent the most frequent involved bacterial species [2,6]. Resistance to third generation cephalosporins (3GC) by Enterobacteriaceae, which represents the major mechanism of antimicrobial resistance among EC isolates, has been reported as independently associated with a poor outcome in HM patients with severe infections caused by EC [4,8,9]. The aim of the present large multicenter study was to identify risk factors for 3GC resistance by EC isolates and prognostic factors, including the impact of 3GC resistance, in HM patients with BSIs caused by EC. The impact of empirical and definitive therapy with carbapenems vs. piperacillin/tazobactam on 30-day mortality was evaluated
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