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

• Published in: PloS one Vol. 14; no. 10; p. e0224465
• Main Authors: Trecarichi, Enrico Maria, Giuliano, Gabriele, Cattaneo, Chiara, Ballanti, Stelvio, Criscuolo, Marianna, Candoni, Anna, Marchesi, Francesco, Laurino, Marica, Dargenio, Michelina, Fanci, Rosa, Cefalo, Mariagiovanna, Delia, Mario, Spolzino, Angelica, Maracci, Laura, Nadali, Gianpaolo, Busca, Alessandro, Del Principe, Maria Ilaria, Daffini, Rosa, Simonetti, Edoardo, Dragonetti, Giulia, Zannier, Maria Elena, Pagano, Livio, Tumbarello, Mario
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29-10-2019; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Antibiotic Prophylaxis; Antibiotics; Antimicrobial agents; Bacteremia - microbiology; Bacteria; Biology and Life Sciences; Cancer; Care and treatment; Cephalosporins; Cephalosporins - therapeutic use; Complications; Drug resistance; Drug Resistance, Multiple, Bacterial - drug effects; E coli; Endoscopes; Escherichia coli; Escherichia coli - drug effects; Escherichia coli - pathogenicity; Escherichia coli Infections - blood; Escherichia coli Infections - epidemiology; Female; Fluoroquinolones; Fluoroquinolones - therapeutic use; Hematologic Neoplasms - complications; Hematologic Neoplasms - microbiology; Hematology; Hospitals; Humans; Infection; Infection Control; Infections; Infectious diseases; Italy - epidemiology; Liver failure; Male; Medical research; Medicine and Health Sciences; Microbial drug resistance; Middle Aged; Mortality; Multidrug resistance; Multivariate analysis; Neoplasm Recurrence, Local - drug therapy; Neutropenia; Neutropenia - complications; Patients; Prophylaxis; Prospective Studies; Rectum; Regression analysis; Research and Analysis Methods; Resistance factors; Risk analysis; Risk Factors; Septic shock; Shock; Stem cells; Surveillance; Transplants & implants; Italy
• ISSN: 1932-6203; 1932-6203
• 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.