Emergence of carbapenem-resistant Enterobacteriaceae as causes of bloodstream infections in patients with hematologic malignancies

Michael J. Satlin, David P. Calfee, Liang Chen, Kathy A. Fauntleroy, Stephen J. Wilson, Stephen G. Jenkins, Eric J. Feldman, Gail J. Roboz, Tsiporah B. Shore, David C. Helfgott, Rosemary Soave, Barry N. Kreiswirth, Thomas J. Walsh

Research output: Contribution to journalArticle

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent pathogens. However, little is known about their emergence in patients with hematologic malignancies. We identified 18 patients with hematologic malignancies over 3.5 years who developed bloodstream infections (BSIs) caused by CRE. Fourteen BSIs were caused by Klebsiella pneumoniae, three by Enterobacter cloacae, and one was polymicrobial. Initial empirical antimicrobial therapy was active in two patients (11%), and a median of 55 h elapsed between culture collection and receipt of an active agent. Ten patients (56%) died, including nine (69%) of 13 neutropenic patients, with a median of 4 days from culture collection until death. CRE isolates were analyzed for carbapenemase production, β-lactamase genes and outer membrane porin deletions and characterized by multilocus sequence typing and pulsed-field gel electrophoresis (PFGE). Carbapenem resistance mechanisms included Klebsiella pneumoniae carbapenemase production and CTX-M-15 production with an absent outer membrane porin protein. No isolate had ≥95% homology on PFGE, indicating a heterogeneous, non-outbreak population of isolates. CRE BSIs are emerging in patients with hematologic malignancies and are associated with ineffective initial empirical therapy, long delays in administration of active antimicrobials and high mortality rates. New diagnostic, therapeutic and preventive strategies for CRE infections in this vulnerable population are needed.

Original languageEnglish (US)
Pages (from-to)799-806
Number of pages8
JournalLeukemia and Lymphoma
Volume54
Issue number4
DOIs
StatePublished - Apr 1 2013

Keywords

  • Antibacterial therapy
  • Bloodstream infections
  • Carbapenem resistance
  • Enterobacteriaceae
  • Hematologic malignancies

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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  • Cite this

    Satlin, M. J., Calfee, D. P., Chen, L., Fauntleroy, K. A., Wilson, S. J., Jenkins, S. G., Feldman, E. J., Roboz, G. J., Shore, T. B., Helfgott, D. C., Soave, R., Kreiswirth, B. N., & Walsh, T. J. (2013). Emergence of carbapenem-resistant Enterobacteriaceae as causes of bloodstream infections in patients with hematologic malignancies. Leukemia and Lymphoma, 54(4), 799-806. https://doi.org/10.3109/10428194.2012.723210