A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies

作者：Vehreschild Maria J G T^*; Hamprecht Axel; Peterson Lisa; Schubert Soren; Hantschel Maik; Peter Silke; Schafhausen Philippe; Rohde Holger; Lilienfeld Toal Marie v; Bekeredjian Ding Isabelle; Libam Johannes; Hellmich Martin; Vehreschild Jorg J; Cornely Oliver A; Seifert Harald

来源：Journal of Antimicrobial Chemotherapy, 2014, 69(12): 3387-3392.

DOI：10.1093/jac/dku305

• febrile neutropenia
• bacteraemia
• bloodstream infections
• intestinal colonization
• infection control
• contact isolation

Bloodstream infections (BSIs) caused by enterobacteria remain a leading cause of mortality in patients with chemotherapy-induced neutropenia. The rate and type of colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-E) and their mode of transmission in German cancer centres is largely unknown. %26lt;br%26gt;We performed a prospective, observational study at five German university-based haematology departments. Participating sites screened for intestinal ESBL-E colonization within 72 h of admission, every 10aEuroS +/- aEuroS2 days thereafter and before discharge. Three of the five centres performed contact isolation for patients colonized or infected with ESBL-E. Molecular characterization of resistance mechanisms and epidemiological typing of isolates by repetitive extragenic palindromic PCR (rep-PCR) and PFGE was performed to assess strain transmission between patients. %26lt;br%26gt;Between October 2011 and December 2012, 719 hospitalizations of 497 haematological high-risk patients comprising 20aEuroS143 patient-days were analysed. Mean duration of in-hospital stay was 36.6 days (range: 2-159 days). ESBL-E were identified from screening samples (82.8% Escherichia coli and 14.6% Klebsiella pneumoniae) in 55/497 patients (11.1%; range by centre: 5.8%-23.1%). PFGE and rep-PCR revealed only a single case of potential cross-transmission among two patients colonized with K. pneumoniae. Six episodes of BSI with ESBL-E were observed. Multivariate analysis revealed previous colonization with ESBL-E as the most important risk factor for BSI with ESBL-E (OR 52.00; 95% CI 5.71-473.89). %26lt;br%26gt;Even though BSI with ESBL-E is still rare in this high-risk population, colonization rates are substantial and vary considerably between centres. In-hospital transmission of ESBL-E as assessed by molecular typing was the exception.

• 出版日期2014-12
• 单位河北医科大学