Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey

Autoři: Enrico Maria Trecarichi aff001;  Gabriele Giuliano aff002;  Chiara Cattaneo aff003;  Stelvio Ballanti aff004;  Marianna Criscuolo aff005;  Anna Candoni aff006;  Francesco Marchesi aff007;  Marica Laurino aff008;  Michelina Dargenio aff009;  Rosa Fanci aff010;  Mariagiovanna Cefalo aff011;  Mario Delia aff012;  Angelica Spolzino aff013;  Laura Maracci aff014;  Gianpaolo Nadali aff015;  Alessandro Busca aff016;  Maria Ilaria Del Principe aff017;  Rosa Daffini aff003;  Edoardo Simonetti aff004;  Giulia Dragonetti aff005;  Maria Elena Zannier aff006;  Livio Pagano aff005;  Mario Tumbarello aff002
Působiště autorů: Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, “Magna Graecia” University, Catanzaro, Italy aff001;  Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy aff002;  Hematology, ASST-Spedali Civili, Brescia, Italy aff003;  Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia, Perugia, Italy aff004;  Dipartimento scienze radiologiche radioterapiche ed ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy aff005;  Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata, Udine, Italy aff006;  Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy aff007;  Department of Medicine, Haematology Unit, University of Padova, Italy aff008;  Unità di Ematologia e Trapianto di cellule staminali, Azienda Ospedaliera Vito Fazzi, Lecce, Italy aff009;  SOD complessa di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Florence, Italy aff010;  Hematology, San Eugenio Hospital, Rome, Italy aff011;  Hematology Section, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy aff012;  Department of Medicine and Surgery, University of Parma, Parma, Italy; Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy aff013;  Clinica di Ematologia Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy aff014;  U.O.C. Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Ospedale Borgo Roma, Verona, Italy aff015;  Department of Hematology and Stem Cell Transplant Unit, AOU Citta' della Salute e della Scienza, Torino, Italy aff016;  Dipartimento di Biomedicina e Prevenzione; Università degli studi di Roma "Tor Vergata", Roma, Italy aff017;  Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy aff018;  Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy aff019
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224465


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.

Klíčová slova:

Antibiotic resistance – Antibiotics – Antimicrobial resistance – Bloodstream infections – Cancer risk factors – Death rates – Escherichia coli – Hematology


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2019 Číslo 10