TY - JOUR
T1 - . Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies.
AU - Spanu, Teresa
AU - Chiusolo, Patrizia
AU - Cauda, Roberto
AU - Pagano, Livio
AU - Trecarichi, Enrico Maria
AU - Tumbarello, Mario
AU - Caira, Morena
AU - Fianchi, Luana
AU - Fadda, Giovanni
AU - Leone, Giuseppe
AU - 33182,
AU - FACOLTA', DI MEDICINA E CHIRURGIA "A.GEMELLI"
AU - ROMA - Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie
AU - 33188,
AU - ematologiche, ROMA - Dipartimento di Scienze radiologiche ed
AU - 33189,
AU - Bioetica, ROMA - Dipartimento di Sicurezza e
PY - 2009
Y1 - 2009
N2 - OBJECTIVES: To identify risk factors for mortality in patients suffering from hematological malignancies with concurrent bacteremia caused by Escherichia coli. Particular attention was focused on defining the impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance by the bacterial isolates on mortality.
MATERIALS AND METHODS: A retrospective eight-year cohort study design was employed. The outcome measured was death within 30 days of the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality.
RESULTS: A total of 62 episodes of bacteremia caused by E. coli were analyzed. The overall incidences of ESBL production and fluoroquinolone resistance were 41.9% and 62.9%, respectively. The overall 30-day mortality rate was 20.9% (13/62). In a multivariate analysis, significant predictors of mortality were inadequate initial antimicrobial therapy (OR=14.96, 95% CI 1.95-114.51; P=0.009), infection caused by ESBL-producing isolates (OR=8.84, 95% CI 1.48-52.91; P=0.01), and prolonged neutropenia (OR=8.10, 95% CI 1.29-50.57; P=0.02).
CONCLUSIONS: Sound knowledge of the local distribution of pathogens and their susceptibility patterns and prompt initiation of effective antimicrobial treatment are essential in patients suffering from hematological malignancies with BSIs caused by E. coli.
AB - OBJECTIVES: To identify risk factors for mortality in patients suffering from hematological malignancies with concurrent bacteremia caused by Escherichia coli. Particular attention was focused on defining the impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance by the bacterial isolates on mortality.
MATERIALS AND METHODS: A retrospective eight-year cohort study design was employed. The outcome measured was death within 30 days of the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality.
RESULTS: A total of 62 episodes of bacteremia caused by E. coli were analyzed. The overall incidences of ESBL production and fluoroquinolone resistance were 41.9% and 62.9%, respectively. The overall 30-day mortality rate was 20.9% (13/62). In a multivariate analysis, significant predictors of mortality were inadequate initial antimicrobial therapy (OR=14.96, 95% CI 1.95-114.51; P=0.009), infection caused by ESBL-producing isolates (OR=8.84, 95% CI 1.48-52.91; P=0.01), and prolonged neutropenia (OR=8.10, 95% CI 1.29-50.57; P=0.02).
CONCLUSIONS: Sound knowledge of the local distribution of pathogens and their susceptibility patterns and prompt initiation of effective antimicrobial treatment are essential in patients suffering from hematological malignancies with BSIs caused by E. coli.
KW - Escherichia coli
KW - Escherichia coli
UR - http://hdl.handle.net/10807/10149
M3 - Article
VL - 2009
SP - 299
EP - 307
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
ER -