Escherichia Coli: an Important Pathogen in Patients with Hematologic Malignancies

BACKGROUND: Escherichia coli (E. coli) is a pathogen of great concern in immunosuppressed patients. While antimicrobial prophylactic therapy has become the standard, the emergence of resistant pathogens has some questioning its use. This study describes our experience with E.coli as a pathogen in neutropenic patients with a hematologic malignancy, and addresses future directions of treatment for this patient population. METHODS: A retrospective chart review of 245 E.coli bacteremia patients at Moffitt Cancer Center from 05/18/02 – 05/15/12 was conducted. Out of 245 patients, 169 did not meet the criteria due to non-neutropenic status, or not diagnosed with a hematologic malignancy, or due to having insufficient medical records. Thus, they were excluded from the study. As a result, 76 patients were involved in this study. Patients were identified via microbiology laboratory computerized records. RESULTS: The included patients experienced clinically significant E.coli bacteremia resulting in a median hospital stay of 14.7 days. Several patients developed severe sepsis requiring the use of pressor and ventilator therapy. CONCLUSIONS: E.coli is a major pathogen in these patient populations resulting in extended hospital stays and specialized treatment to overcome their E.coli bacteremia. The data supports the use of fluoroquinolone prophylactic therapy, however, earlier detection and treatment of neutropenic infection is needed.