Correlation between Multidrug-Resistant Bacteria Colonization and Bloodstream Infections in Children with Hematolymphoid Malignancies at a Tertiary Cancer Center in India
Background Bloodstream infections with drug-resistant bacteria are associated with a higher morbidity and mortality. Based on previous studies in our institution demonstrating a rising incidence of multidrug resistant organism (MDR) bacteria in bloodstream infections (BSI) and high prevalence of enteric colonization with MDR, the “de-escalation” strategy for empirical antibiotics was adopted in the management of febrile neutropenia in children with hematolymphoid malignancies and MDR colonization. An audit was carried out to determine whether surveillance rectal swabs correlated with blood cultures in febrile neutropenia.
Methods Patient data from January 2015 to July 2016 was examined. Rectal swabs of children with hematolymphoid malignancies were obtained at presentation. Blood cultures were taken during febrile neutropenia. Data were analyzed using SPSS version 24.0. The significance level was set at p < 0.05.
Results Most patients (62.1%) with confirmed BSI were colonized with either extended-spectrum β-lactamase producing organisms (ESBLO) (31.9%) or MDR (30.2%). Majority 116 (62.7%) developed BSI caused by either MDR or ESBLO. In contrast, only 12 (10.6%) patients colonized by sensitive bacteria, developed BSI caused by either MDR or ESBLO. These differences were statistically significant (p < 0.001). Thus, the baseline rectal swab had a sensitivity and a specificity of 90.6% and 59.4%, respectively, in predicting BSI with either MDR or ESBLO.
Conclusions We conclude that high prevalence of MDR colonization at presentation significantly results in MDR BSI, which further results in a significant increase in intensive care unit admissions and mortality. This would justify the use of a “de-escalation” antibiotic policy. Whether such a strategy has been successful in impacting outcomes, would need further study.
28. Mai 2021 (online)
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- 1 Radhakrishnan V, Vijaykumar V, Ganesan P, Rajendranath R, Trivadi G, Tenali S. Bloodstream infections in pediatric patients at Cancer Institute, Chennai. Indian J Cancer 2014; 51 (04) 418-419
- 2 Averbuch D, Orasch C, Cordonnier C. et al. ECIL4, a joint venture of EBMT, EORTC, ICHS, ESGICH/ESCMID and ELN. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2013; 98 (12) 1826-1835
- 3 Magiorakos AP, Srinivasan A, Carey RB. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18 (03) 268-281
- 4 Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005; 18 (04) 657-686
- 5 Thacker N, Pereira N, Banavali SD. et al. Epidemiology of blood stream infections in pediatric patients at a tertiary care cancer centre. Indian J Cancer 2014; 51 (04) 438-441
- 6 Prabhash K, Medhekar A, Ghadyalpatil N. et al. Blood stream infections in cancer patients: a single center experience of isolates and sensitivity pattern. Indian J Cancer 2010; 47 (02) 184-188
- 7 Mikulska M, Viscoli C, Orasch C. et al. Fourth European Conference on Infections in Leukemia Group (ECIL-4), a joint venture of EBMT, EORTC, ICHS, ELN and ESGICH/ESCMID. Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients. J Infect 2014; 68 (04) 321-331
- 8 Thacker N, Pereira N, Banavali SD. et al. Alarming prevalence of community-acquired multidrug-resistant organisms colonization in children with cancer and implications for therapy: A prospective study. Indian J Cancer 2014; 51 (04) 442-446
- 9 Ford CD, Lopansri BK, Haydoura S. et al. Frequency, risk factors, and outcomes of vancomycin-resistant Enterococcus colonization and infection in patients with newly diagnosed acute leukemia: different patterns in patients with acute myelogenous and acute lymphoblastic leukemia. Infect Control Hosp Epidemiol 2015; 36 (01) 47-53
- 10 Cornejo-Juárez P, Suárez-Cuenca JA, Volkow-Fernández P. et al. Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies. Support Care Cancer 2016; 24 (01) 253-259
- 11 Van Leeuwen PA, Boermeester MA, Houdijk AP. et al. Clinical significance of translocation. Gut 1994; 35 (01) (Suppl. 01) S28-S34
- 12 Bassetti M, Righi E. Multidrug-resistant bacteria: what is the threat?. Hematology (Am Soc Hematol Educ Program) 2013; 2013: 428-432
- 13 Kang CI, Chung DR, Ko KS, Peck KR, Song JH. Korean Network for Study of Infectious Diseases. Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy. Ann Hematol 2012; 91 (01) 115-121
- 14 Gudiol C, Calatayud L, Garcia-Vidal C. et al. Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother 2010; 65 (02) 333-341
- 15 Shankar K, Radhakrishnan V, Vijayakumar V. et al. Prevalence of multi-drug resistant organisms in stool of paediatric patients with acute leukaemia and correlation with blood culture positivity: A single institution experience. Pediatr Blood Cancer 2018; 65 (01) e26740
- 16 Indian Council for Medical Research. Department of Health Research Treatment Guidelines for Antimicrobial use in Common Syndromes. Available at: https://www.icmr.nic.in/ sites/default/files/guidelines/Treatment_guidelines_2017.pdf. Accessed July 10, 2017
- 17 Nesher L, Rolston KV, Shah DP. et al. Fecal colonization and infection with Pseudomonas aeruginosa in recipients of allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2015; 17 (01) 33-38
- 18 Gudiol C, Ayats J, Camoez M. et al. Increase in bloodstream infection due to vancomycin-susceptible Enterococcus faecium in cancer patients: risk factors, molecular epidemiology and outcomes. PLoS One 2013; 8 (09) e74734
- 19 Vergis EN, Hayden MK, Chow JW. et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia. a prospective multicenter study. Ann Intern Med 2001; 135 (07) 484-492
- 20 DiazGranados CA, Jernigan JA. Impact of vancomycin resistance on mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis 2005; 191 (04) 588-595