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Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies

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Abstract

Background

In patients with haematological or oncological malignancies, we aimed to assess the rate of intestinal colonisation and blood stream infections (BSI) with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) and vancomycin-resistant enterococci (VRE), mortality and risk factors associated with ESBLE/VRE BSI, as well as the impact of faecal screening for ESBLE and VRE in combination with adapted empiric treatment of febrile neutropenia.

Methods

Within 72 h of admission to our department, an ESBLE and VRE screening stool sample was collected. In the case of neutropenic fever, blood cultures were drawn. Data of all admitted patients were prospectively documented. Explorative forward-stepwise logistic regression analyses were used to identify risk factors for progression from intestinal colonisation to BSI.

Results

During the study period, 1,805 stool samples were obtained from 513 patients during 1,012 inpatient stays, and 2,766 blood cultures were obtained from 578 patients during 1,091 inpatient stays. Ninety (17.5 %) of these patients were colonised with ESBLE and 51 (9.9 %) with VRE. Proportions of 40 % (36/90) of ESBLE and 61 % (31/51) of VRE colonisations were healthcare-associated. Six of 90 (6.6 %) ESBLE-colonised patients and 1/51 (2 %) VRE-colonised patients developed BSI with the respective organism. None of these patients died after receiving early appropriate empiric antibiotics based on colonisation status. Colonisation with ESBLE or VRE was associated with increased risk ratios (RR) towards developing ESBLE BSI [RR 4.5, 95 % confidence interval (CI): 2.89–7.04] and VRE BSI (RR 10.2, 95 % CI: 7.87–13.32), respectively. Acute myelogenous leukaemia and prior treatment with platinum analogues or quinolones were identified as independent risk factors for ESBLE BSI in colonised patients.

Conclusions

Intestinal ESBLE/VRE colonisation predicts BSI. Faecal screening in haematology/oncology patients in combination with directed empiric treatment may reduce ESBLE BSI-related mortality.

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Acknowledgements

We would like to thank the entire staff of the Institute for Medical Microbiology, Immunology and Hygiene (IMMIH), as well as our documentation assistants Bibi Bos, Daniela Ziegler, Juliane Pickenhain, Luisa Weise, Marie Baltes and Meike Freund for their support. We would like to extend a special thanks to Susanna Proske for her extensive support during the file search.

Funding

The study was funded by the University Hospital Cologne.

Conflict of interest

O.A.C is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN1106), has received research grants from Actelion, Astellas, Basilea, Bayer, Biocryst, Celgene, F2G, Genzyme, Gilead, Merck/Schering, Miltenyi, Optimer, Pfizer, Quintiles and Viropharma, is a consultant to Astellas, Basilea, F2G, Gilead, Merck/Schering, Optimer and Pfizer, and received lecture honoraria from Astellas, Gilead, Merck/Schering and Pfizer.

M.J.G.T.V. has been a speaker for Astellas Pharma, Gilead Sciences, Merck/MSD and Pfizer.

J.J.V. has received research grants from or has been a speaker for Astellas, Merck, Pfizer and Schering-Plough.

G.F. is supported by the German Federal Ministry of Research and Education (BMBF grant 01KI0771) and has received lecture fees from Gilead, Glaxo Smith Kline, Janssen, Merck Sharp & Dohme, Novartis and Pfizer.

H.S. is supported by research grants from Basilea, Novartis and Pfizer, has received speaking fees from Bayer, Gilead, Novartis, Oxoid and Pfizer, and is a consultant to Astellas, Astra-Zeneca and Novartis.

H.W. has been a speaker for bioMérieux, Siemens, Bruker and GenProbe.

M.H. and B.J.L. have no conflicts of interest.

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Correspondence to M. J. G. T. Vehreschild.

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Liss, B.J., Vehreschild, J.J., Cornely, O.A. et al. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 40, 613–619 (2012). https://doi.org/10.1007/s15010-012-0269-y

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