Vehreschild, Maria J. G. T., Hamprecht, Axel ORCID: 0000-0003-1449-5780, Peterson, Lisa, Schubert, Soren, Hantschel, Maik, Peter, Silke ORCID: 0000-0002-1355-3953, Schafhausen, Philippe, Rohde, Holger, Lilienfeld-Toal, Marie v., Bekeredjian-Ding, Isabelle ORCID: 0000-0001-6646-5888, Libam, Johannes, Hellmich, Martin, Vehreschild, Jorg J., Cornely, Oliver A. and Seifert, Harald (2014). A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies. J. Antimicrob. Chemother., 69 (12). S. 3387 - 3393. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

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. 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. 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). 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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Vehreschild, Maria J. G. T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamprecht, AxelUNSPECIFIEDorcid.org/0000-0003-1449-5780UNSPECIFIED
Peterson, LisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schubert, SorenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hantschel, MaikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Peter, SilkeUNSPECIFIEDorcid.org/0000-0002-1355-3953UNSPECIFIED
Schafhausen, PhilippeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rohde, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lilienfeld-Toal, Marie v.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bekeredjian-Ding, IsabelleUNSPECIFIEDorcid.org/0000-0001-6646-5888UNSPECIFIED
Libam, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hellmich, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Jorg J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seifert, HaraldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-422529
DOI: 10.1093/jac/dku305
Journal or Publication Title: J. Antimicrob. Chemother.
Volume: 69
Number: 12
Page Range: S. 3387 - 3393
Date: 2014
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2091
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LACTAMASE-PRODUCING ENTEROBACTERIACEAE; INTENSIVE-CARE UNITS; BLOOD-STREAM INFECTIONS; (ESBL)-PRODUCING ENTEROBACTERIACEAE; ANTIMICROBIAL SUSCEPTIBILITY; RESISTANCE; SURVEILLANCE; HUMANS; TRENDS; COLIMultiple languages
Infectious Diseases; Microbiology; Pharmacology & PharmacyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42252

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