Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients – Review of the literature from a clinical perspective

Abstract

Background: The prevalence of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) is increasing worldwide. ESBL-E are known to colonize different body sites and cause bloodstream infections (BSI), pneumonia, intra-abdominal infections and urinary tract infections. Even though ESBL-E-related morbidity and mortality in high-risk patients – patients receiving immunosuppressants or chemotherapy, as well as those treated in an ICU – is considerable, the management of ESBL-E in these populations has not been systematically reviewed. Methods: For the purpose of this review, ICU patients, patients in hematology and oncology wards and transplant recipients were considered high-risk. An English-language Medline search was conducted to identify literature on epidemiology, risk factors, clinical impact and measures of infection control regarding ESBL-E in high-risk patients published between June 2002 and May 2013. Results: Using the above described methodology, 43 relevant articles regarding high-risk patients and – for areas where literature on exclusively high-risk patients is scarce – 17 articles in standard risk settings were identified. The evidence on epidemiology, associated risk factors, treatment and hygiene measures were summarized. Discussion: This review gives a complete overview on the management of ESBL-E in the high-risk setting.

• Bloodstream infection
• colonization
• ESBL
• ICU
• malignancy
• neutropenia

Acknowledgements

We did not receive any funding or external help for the completion of this article. We would like to thank Karen Pankraz, Elizabeth New and Katrin McCloy for their reliable and timely assistance during the literature search.

Declaration of interest

LMB has received lecture honoraria from Astellas and MSD. MSH reports no declarations of interest. BL reports no declarations of interest. OAC is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN1106) and has received research grants from, is an advisor to, or received lecture honoraria from 3M, Actelion, Astellas, Basilea, Bayer, Celgene, Cubist, F2G, Genzyme, Gilead, GSK, Merck/MSD, Miltenyi, Optimer, Pfizer, Quintiles, Sanofi Pasteur, Viropharma. MJGTV has served on the speakers’ bureau of Schering-Plough/Essex, Pfizer, MSD and Gilead Sciences. She has received a research grant from 3M.