Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey

Enrico Maria Trecarichi, Gabriele Giuliano, Chiara Cattaneo, Stelvio Ballanti, Marianna Criscuolo, Anna Candoni, Francesco Marchesi, Marica Laurino, Michelina Dargenio, Rosa Fanci, Mariagiovanna Cefalo, Mario Delia, Angelica Spolzino, Laura Maracci, Gianpaolo Nadali, Alessandro Busca, Maria Ilaria Del Principe, Rosa Daffini, Edoardo Simonetti, Giulia DragonettiMaria Elena Zannier, Livio Pagano, Mario Tumbarello

Research output: Contribution to journalArticle

Abstract

Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.

Original languageEnglish
Pages (from-to)e0224465
JournalPLoS One
Volume14
Issue number10
DOIs
Publication statusPublished - Jan 1 2019

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Trecarichi, E. M., Giuliano, G., Cattaneo, C., Ballanti, S., Criscuolo, M., Candoni, A., Marchesi, F., Laurino, M., Dargenio, M., Fanci, R., Cefalo, M., Delia, M., Spolzino, A., Maracci, L., Nadali, G., Busca, A., Del Principe, M. I., Daffini, R., Simonetti, E., ... Tumbarello, M. (2019). Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey. PLoS One, 14(10), e0224465. https://doi.org/10.1371/journal.pone.0224465