Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies Journal Article
| Authors: | Satlin, M. J.; Cohen, N.; Ma, K. C.; Gedrimaite, Z.; Soave, R.; Askin, G.; Chen, L.; Kreiswirth, B. N.; Walsh, T. J.; Seo, S. K. |
| Article Title: | Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies |
| Abstract: | Objectives To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies. Methods We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case. Results CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior β-lactam/β-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08). Conclusions CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population. © 2016 The British Infection Association |
| Keywords: | adult; controlled study; aged; major clinical study; neutropenia; nonhuman; prevalence; risk factors; hematologic malignancy; hematologic malignancies; ciprofloxacin; glucocorticoid; bacteremia; gentamicin; bloodstream infection; new york; cotrimoxazole; levofloxacin; quinoline derived antiinfective agent; outcomes; tobramycin; ceftriaxone; piperacillin plus tazobactam; gram negative sepsis; cefepime; blood culture; hospital based case control study; ceftazidime; carbapenem; meropenem; aminoglycoside antibiotic agent; imipenem; mortality rate; amikacin; polymyxin b; neutropenic patients; ertapenem; prognosis; human; male; female; article; beta lactam antibiotic; tigecycline; aztreonam; carbapenem-resistant enterobacteriaceae; avibactam plus ceftazidime; beta lactamase inhibitor; carbapenem resistant enterobacteriaceae |
| Journal Title: | Journal of Infection |
| Volume: | 73 |
| Issue: | 4 |
| ISSN: | 0163-4453 |
| Publisher: | W.B. Saunders Co. |
| Date Published: | 2016-10-01 |
| Start Page: | 336 |
| End Page: | 345 |
| Language: | English |
| DOI: | 10.1016/j.jinf.2016.07.002 |
| PROVIDER: | scopus |
| PMCID: | PMC5026910 |
| PUBMED: | 27404978 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 November 2016 -- Source: Scopus |
