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J Infect. 2016 Oct;73(4):336-45. doi: 10.1016/j.jinf.2016.07.002. Epub 2016 Jul 9.

Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies.

Author information

1
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA. Electronic address: mjs9012@med.cornell.edu.
2
Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: cohenn@mskcc.org.
3
Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA. Electronic address: kcm9006@nyp.org.
4
Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: gedrimaz@mskcc.org.
5
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA. Electronic address: rsoave@med.cornell.edu.
6
Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. Electronic address: gua2004@med.cornell.edu.
7
Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address: chen11@njms.rutgers.edu.
8
Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address: kreiswba@njms.rutgers.edu.
9
Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA; Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA; Department of Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA. Electronic address: thw2003@med.cornell.edu.
10
Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: seos@mskcc.org.

Abstract

OBJECTIVES:

To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies.

METHODS:

We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case.

RESULTS:

CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior β-lactam/β-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08).

CONCLUSIONS:

CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population.

KEYWORDS:

Bacteremia; Carbapenem-resistant Enterobacteriaceae; Hematologic malignancies; Neutropenic patients; Outcomes; Prevalence; Risk factors

PMID:
27404978
PMCID:
PMC5026910
DOI:
10.1016/j.jinf.2016.07.002
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Potential conflicts of interest. M.J.S. has received research grants/contracts from Allergan and Achaogen. T.J.W. has received research grants/contracts from Allergan and Merck. All other authors report no potential conflicts of interest.

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