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478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies

BACKGROUND: Infections with extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae is an emerging problem leading to poor clinical outcomes and increased mortality. The purpose of this study was to determine the prevalence, risk factors and outcomes of ESBL-producing E. coli (EC) in blood...

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Autores principales: Aslam, Sadaf, Denham, James, Greene, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810759/
http://dx.doi.org/10.1093/ofid/ofz360.551
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author Aslam, Sadaf
Denham, James
Greene, John
author_facet Aslam, Sadaf
Denham, James
Greene, John
author_sort Aslam, Sadaf
collection PubMed
description BACKGROUND: Infections with extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae is an emerging problem leading to poor clinical outcomes and increased mortality. The purpose of this study was to determine the prevalence, risk factors and outcomes of ESBL-producing E. coli (EC) in bloodstream infections (BSIs) of neutropenic patients with hematological malignancies and compare the difference with Non-ESBL producing EC. METHODS: Through an IRB approved protocol, a retrospective cohort study was conducted at the H. Lee Moffitt Cancer Center from January, 2007 till October, 2017. Of the 310 records, who had +ive blood cultures for E. Coli, a total of 63 neutropenic patients with hematological malignancies were identified based on the bloodstream infections with ESBL-EC and Non ESBL EC. Data included demographics, underlying malignancy, type of bone marrow transplant, duration of neutropenia, antibiotics use pre and post culture, length of hospital stay, severity of infection, ventilator use, and mortality data. RESULTS: A total of 310 cases with hematological malignancy and neutropenia were reviewed, 63 were identified as +ive blood culture for E. coli. Out of the 63 cases, 17 were ESBL-EC +ive and 46 were non-ESBL-EC. The prevalence of ESBL-EC was highest in the year 2015 (29.4%) and decreased in the subsequent years (Figure 1). The mean ages of the two groups were 53.59 ±12.4 and 60.82 ± 11.1, respectively. The average length of stay for the ESBL-EC group was 26.59 ± 11.2 days, longer than the non-ESBL EC group 21.96 ± 11.2. Days of neutropenia in non-ESBL vs. ESBL EC were 9 days ± 8.3, and 19 days ± 22.0, respectively, P < 0.01). No differences were observed in the 30–60 day mortality and other outcomes listed in Table 1. CONCLUSION: The prevalence of ESBL-EC was observed to be higher in patients who were neutropenic for longer duration, were older and resulted in longer hospital stay. Early identification and empirical therapy in neutropenic patients suspected to have ESBL-EC infection is crucial. Also, the infection with ESBL-EC was higher in the year 2015 and decreased in the subsequent years. After higher rates, perhaps infection control, lab reporting changes, antibiotic stewardship and transmission-based precautions might have played a role. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68107592019-10-28 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies Aslam, Sadaf Denham, James Greene, John Open Forum Infect Dis Abstracts BACKGROUND: Infections with extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae is an emerging problem leading to poor clinical outcomes and increased mortality. The purpose of this study was to determine the prevalence, risk factors and outcomes of ESBL-producing E. coli (EC) in bloodstream infections (BSIs) of neutropenic patients with hematological malignancies and compare the difference with Non-ESBL producing EC. METHODS: Through an IRB approved protocol, a retrospective cohort study was conducted at the H. Lee Moffitt Cancer Center from January, 2007 till October, 2017. Of the 310 records, who had +ive blood cultures for E. Coli, a total of 63 neutropenic patients with hematological malignancies were identified based on the bloodstream infections with ESBL-EC and Non ESBL EC. Data included demographics, underlying malignancy, type of bone marrow transplant, duration of neutropenia, antibiotics use pre and post culture, length of hospital stay, severity of infection, ventilator use, and mortality data. RESULTS: A total of 310 cases with hematological malignancy and neutropenia were reviewed, 63 were identified as +ive blood culture for E. coli. Out of the 63 cases, 17 were ESBL-EC +ive and 46 were non-ESBL-EC. The prevalence of ESBL-EC was highest in the year 2015 (29.4%) and decreased in the subsequent years (Figure 1). The mean ages of the two groups were 53.59 ±12.4 and 60.82 ± 11.1, respectively. The average length of stay for the ESBL-EC group was 26.59 ± 11.2 days, longer than the non-ESBL EC group 21.96 ± 11.2. Days of neutropenia in non-ESBL vs. ESBL EC were 9 days ± 8.3, and 19 days ± 22.0, respectively, P < 0.01). No differences were observed in the 30–60 day mortality and other outcomes listed in Table 1. CONCLUSION: The prevalence of ESBL-EC was observed to be higher in patients who were neutropenic for longer duration, were older and resulted in longer hospital stay. Early identification and empirical therapy in neutropenic patients suspected to have ESBL-EC infection is crucial. Also, the infection with ESBL-EC was higher in the year 2015 and decreased in the subsequent years. After higher rates, perhaps infection control, lab reporting changes, antibiotic stewardship and transmission-based precautions might have played a role. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810759/ http://dx.doi.org/10.1093/ofid/ofz360.551 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Aslam, Sadaf
Denham, James
Greene, John
478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title_full 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title_fullStr 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title_full_unstemmed 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title_short 478. Outcomes of Extended-Spectrum β-Lactamase-Producing Escherichia coli Bloodstream Infection in Neutropenic Patients with Hematological Malignancies
title_sort 478. outcomes of extended-spectrum β-lactamase-producing escherichia coli bloodstream infection in neutropenic patients with hematological malignancies
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810759/
http://dx.doi.org/10.1093/ofid/ofz360.551
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