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

Michael J. Satlin, Nina Cohen, Kevin C. Ma, Zivile Gedrimaite, Rosemary Soave, Gülce Askin, Liang Chen, Barry N. Kreiswirth, Thomas J. Walsh, Susan K. Seo

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)336-345
Number of pages10
JournalJournal of Infection
Volume73
Issue number4
DOIs
StatePublished - Oct 1 2016

Keywords

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

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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