Molecular analysis and risk factors for escherichia coli producing extended-spectrum ß-lactamase bloodstream infection in hematological malignancies
Por:
Cornejo-Juárez P., Pérez-Jiménez C., Silva-Sánchez J., Velázquez-Acosta C., González-Lara F., Reyna-Flores F., Sánchez-Pérez A., Volkow-Fernández P.
Publicada:
1 ene 2012
Resumen:
Introduction: Patients with hematologic malignancies have greater risk-factors for primary bloodstream infections (BSI). Methods: From 2004-2009, we analyzed bacteremia caused by extended-spectrum beta-lactamase Escherichia coli (ESBL-EC) (n = 100) and we compared with bacteremia caused by cephalosporin-susceptible E. coli (n = 100) in patients with hematologic malignancies. Objective: To assess the clinical features, risk factors, and outcome of ESBL-EC BSI in patients with hematologic malignancies, and to study the molecular epidemiology of ESBL-EC isolates. Results: The main diagnosis was acute leukemia in 115 patients (57.5%). Death-related E. coli infection was significantly increased with ESBL-EC (34% vs. control group, 19%; p = 0.03). Treatment for BSI was considered appropriate in 64 patients with ESBL-EC (mean survival, 245±345 days), and in 45 control patients this was 443±613 (p = 0.03). In patients not receiving appropriate antimicrobial treatment, survival was significantly decreased in cases compared with controls (26±122 vs. 276±442; p = 0.001). Fifty six of the ESBL-EC isolates were characterized by molecular analysis: 47 (84%) expressed CTX-M-15, two (3.6%) SHV, and seven (12.5%) did not correspond to either of these two ESBL enzymes. No TLA-1 enzyme was detected. Conclusions: Patients who had been previously hospitalized and who received cephalosporins during the previous month, have an increased risk of ESBL-EC bacteremia. Mortality was significantly increased in patients with ESBL-EC BSI. A polyclonal trend was detected, which reflects non-cross transmission of multiresistant E.coli isolates. © 2012 Cornejo-Juárez et al.
Filiaciones:
Cornejo-Juárez P.:
Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (Ssa), Mexico City, Mexico
Pérez-Jiménez C.:
Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (Ssa), Mexico City, Mexico
Silva-Sánchez J.:
Departament of Epidemiologic Diagnosis, Instituto Nacional de Salud Pública (INSP), Centro de Investigaciones sobre Enfermedades Infecciosas (CISEI), Ssa, Cuernavaca, Morelos, Mexico
Velázquez-Acosta C.:
Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (Ssa), Mexico City, Mexico
González-Lara F.:
Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (Ssa), Mexico City, Mexico
Reyna-Flores F.:
Departament of Epidemiologic Diagnosis, Instituto Nacional de Salud Pública (INSP), Centro de Investigaciones sobre Enfermedades Infecciosas (CISEI), Ssa, Cuernavaca, Morelos, Mexico
Sánchez-Pérez A.:
Departament of Epidemiologic Diagnosis, Instituto Nacional de Salud Pública (INSP), Centro de Investigaciones sobre Enfermedades Infecciosas (CISEI), Ssa, Cuernavaca, Morelos, Mexico
Volkow-Fernández P.:
Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (Ssa), Mexico City, Mexico
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