Universität zu Köln

Liss, B. J., Vehreschild, J. J., Cornely, O. A., Hallek, M., Faetkenheuer, G., Wisplinghoff, H., Seifert, H. and Vehreschild, M. J. G. T. (2012). 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 (6). S. 613 - 620. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 0300-8126

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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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liss, B. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, J. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Faetkenheuer, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wisplinghoff, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, M. J. G. T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-477715
DOI:	10.1007/s15010-012-0269-y
Journal or Publication Title:	Infection
Volume:	40
Number:	6
Page Range:	S. 613 - 620
Date:	2012
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	0300-8126
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STEM-CELL TRANSPLANT; ESCHERICHIA-COLI; RISK-FACTORS; BACTEREMIA; CONSEQUENCES; LEUKEMIA; CANCER; COHORT Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47771