Rectal colonization with multidrug-resistant gram-negative bacteria in patients with hematological malignancies: a prospective study

ABSTRACT

Objectives

To investigate the risk factors for rectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) in hematological malignant patients with febrile neutropenia (FN); rate of rectal colonization and infection/colonization with CRE and ESBL-E; whether empirical treatment can be revised.

Methods

Adult patients receiving chemotherapy were included. Rectal swab cultures of patients were screened for CRE and ESBL-E using selective chromogenic agars.

Results

Fifty-seven FN episodes of 57 patients were studied. Rectal colonization rates were 40.4% (23/57) and 8.8% (5/57) for ESBL-E and CRE, respectively. ESBL-E bacteremia was diagnosed in 2 (8.6%) ESBL-E colonized patients, while CRE bacteremia was detected in 1 (20%) CRE colonized patient. Amikacin (100%) and carbapenem (93%) were the most effective antibiotics against gram-negative enteric bacteria. Beta-lactam usage within the last 3 months was a significant risk factor for ESBL-E colonization.

Conclusions

For the treatment of FN patients either colonized with ESBL-E or having significant risk factors for ESBL-E infection, aminoglycoside containing combinations may become an alternative to carbapenems due to their high sensitivity rates. When CRE colonized hematological cancer patients develop FN or if they are hemodynamically unstable, CRE covering empiric antibiotherapy should be preferred due to high mortality rates of CRE bacteremia.

KEYWORDS:

• Febrile neutropenia
• intestinal colonization
• rectal carriage
• multi-drug resistant
• hematological malignancies
• carbapenem-resistant Enterobacteriaceae
• extended-spectrum ß-lactamase-producing Enterobacteriaceae

Author contributions

Conception – Burak Kömürcü, Elif Tükenmez Tigen; Design – Burak Kömürcü, Elif Tükenmez Tigen; Supervision – Volkan Korten; Fundings – Volkan Korten; Materials – Burak Kömürcü, Elif Tükenmez Tigen, Tayfur Toptaş, Tülin Fıratlı Tuğlular; Data Collection and/or Processing – Burak Kömürcü; Analysis And/Or Interpretation – Burak Kömürcü, Tayfur Toptaş; Literature Review – Burak Kömürcü; Writer – Burak Kömürcü, Elif Tükenmez Tigen

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was supported by Marmara University Scientific Research Projects Committee as project number SAG-C-TUP-100616-0264.