Intestinal Colonization with Carbapenem-Resistant Enterobacteriaceae in Acute Leukemia Patients: Risk Factors and Molecular Characteristics

Figures & data

Table 1 Comparison of Demographic Factors Among CRE and Non-CRE Groups

No. of Cases (n=320)	CRE (n=21)	Non-CRE (n=299)
Age
Pediatric (20)	5 (25.00%)	15 (75.00%)
Adult (300)	16 (5.33%)	284 (94.67%)
Sex
Male (180)	16 (8.89%)	164 (91.11%)
Female (140)	5 (3.57%)	135 (96.43%)
Diagnosis
ALL (104)	6 (5.77%)	98 (94.23%)
AML (215)	15 (6.98%)	200 (93.02%)
MAL (1)	0	1 (100%)
Fever
Fever (184)	19 (10.33%)	165 (89.67%)
Non-febrile (136)	2 (1.47%)	134 (98.53%)
Discharge
Yes (248)	9 (3.63%)	239 (96.37%)
No (72)	12 (16.67%)	60 (83.33%)
Chemotherapy
Yes (286)	19 (6.64%)	267 (93.36%)
No (34)	2 (5.82%)	32 (94.12%)

Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; ALL, acute lymphoid leukemia; AML, acute myeloid leukemia; MAL, acute mixed lineage leukemia.

Table 2 Univariate Analysis and Multivariate Logistic Regression Analysis of Risk Factors for CRE Colonization in Colonized versus Non-Colonized Patients

Variables	CRE Colonized n (%)	Non-Colonized n (%)	Bivariate		Multivariate
Total No. of Patients	N=21 (6.56)	N=299 (93.44)	OR (95% CI)	p	OR (95% CI)	p
Age range (14 to 79years)	16 (76.19)	284 (94.98)	0.122 (0.038–0.394)	0.000	0.212 (0.056–0.807)	0.023
Sex (male)	16 (76.19)	164 (54.85)	2.634 (0.941–7.376)	0.065
ECOG (3 to 5)	7 (33.33)	95 (31.77)	1.074 (0.420–2.747)	0.882
Hospital stays (50 to 410 days)	19 (90.48)	225 (75.25)	3.124 (0.711–13.732)	0.132
No. of admissions (6 to 50)	15 (71.43)	140 (46.82)	2.363 (0.844–6.619)	0.102
Clinical Diagnosis	n (%)	n (%)	OR (95% CI)	p	OR (95% CI)	p
ALL	6 (28.57)	98 (32.78)	0.820 (0.309–2.180)	0.691
AML	15 (71.43)	200 (66.89)	1.237 (0.466–3.287)	0.669
MAL	0	1 (0.33)	0	1
Gastrointestinal symptoms	12 (57.14)	144 (48.16)	1.794 (0.704–4.343)	0.228
Invasive Operation	n (%)	n (%)	OR (95% CI)	p	OR (95% CI)	p
PICC	9 (42.86)	174 (58.19)	0.539 (0.220–1.318)	0.175
Chemotherapy	19 (90.48)	267 (89.30)	1.139 (0.253–5.115)	0.866
Refractory	9 (42.86)	83 (27.76)	1.952 (0.793–4.803)	0.146
Neutrophils	n (%)	n (%)	OR (95% CI)	p	OR (95% CI)	p
Decreased	17 (80.95)	194 (64.88)	2.300 (0.754–7.013)	0.143
History of antibiotic intake within last 3 months
Carbapenems	18 (85.71)	199 (66.56)	3.015 (0.868–10.478)	0.082
Quinolones	9 (42.86)	80 (26.76)	2.053 (0.834–5.057)	0.118
Cephalosporins	10 (47.62)	29 (9.70)	8.464 (3.312–21.627)	0.000	2.205 (1.099–4.424)	0.026
Tigecyclines	9 (42.86)	51 (17.06)	3.647 (1.46–9.109)	0.006	1.968 (1.17–3.311)	0.011
Penicillins	10 (47.62)	71 (23.75)	2.919 (1.191–7.158)	0.019	1.364 (0.693–2.685)	0.369
Hematopoietic stem cell transplantation	16 (76.19)	118 (39.46)	4.908 (1.751–13.757)	0.002	0.364 (0.115–1.155)	0.086

Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; ECOG, Eastern Cooperative Oncology Group; ALL, acute lymphoid leukemia; AML, acute myeloid leukemia; MAL, acute mixed lineage leukemia; PICC, Peripherally Inserted Central Catheter; n, number of patients; OR, odds ratio; 95% CI, confidence interval; p, test significance.

Table 3 Univariate Analysis of the Risk of Development of Invasive Clinical CRE Infection in the Sample

Infection	CRE Colonized n (%)	Controls n (%)	OR (95% CI)	p
Yes	3 (14.29)	8 (2.68)	6.062 (1.481–24.825)	0.012
No	18 (85.71)	291 (97.32)
Total	21	299

Abbreviations: CRE, Carbapenem-resistant Enterobacteriaceae; n, number of patients; OR, odds ratio; 95% CI, confidence interval; p, test significance.

Figure 1 Susceptibility of 21 CRE colonized isolates to different antimicrobial agents.

Figure 2 Distribution of MIC values of different types of antibiotics determined by broth micro-dilution method.

Abbreviations: MIC, the minimal inhibitory concentration; µg/mL, micrograms per milliliter.

Figure 3 Molecular characterization of carbapenemase genes and virulence genes in CRE isolates as detected by PCR. (A) Virulence factors of Klebsiella pneumoniae in colonized bacterium. (B) Virulence factors of Escherichia coli in colonized bacterium. (C) carbapenemase genes in CRE isolates.