title: Bacteremias caused by Escherichia coli in cancer patients - analysis of 65 episodes.
abstract: OBJECTIVE
  The aims of this study were to evaluate risk factors, clinical presentation, outcome and antimicrobial susceptibility in patients with Escherichia coli bacteremia occurring over seven years in a single cancer hospital.
  
  
  METHODS
  Sixty five episodes of bacteremia from E. coli appearing over seven years from 12,301 admissions in a single cancer institution were retrospectively analyzed.
  
  
  RESULTS
  The proportion of bacteremia caused by E. coli among Gram-negative bacteremia was 20.8% (the second most common organism after Pseudomonas aeruginosa), and infection-associated mortality was 17%. The incidence in 1989-1995 varied from 14.3 to 24.7%. The most common risk factors were: solid tumors as the underlying disease (70.7%); central venous catheter insertion (32.3%); prior surgery (46.2%), and prior chemotherapy within 48 h (44.4%). Neutropenia and urinary catheters did not place patients at high risk in any of the subgroups. When we compared the two subgroups of 61 cases of bacteremia - monomicrobial and polymicrobial (when E. coli was isolated from blood culture with another microorganism) - we found that acute leukemia and breakthrough (recurrence while receiving antibiotics) bacteremia were more frequently associated with polymicrobial E. coli bacteremia. There was also a difference in infection-associated mortality: monomicrobial bacteremia due to E. coli only had a significantly lower mortality in comparison with polymicrobial E. coli bacteremia (8.9 vs 35.0%, respectively; P<0.03).
  
  
  CONCLUSIONS
  The susceptibility of 115 E. coli strains isolated from 65 episodes of bacteremia was stable. Only two episodes caused by quinolone-resistant strains occurred, both in 1995, after six years of using ofloxacin for prophylaxis in neutropenic patients in our hospital. We found that 85.2-91.3% of all strains were susceptible to aminoglycosides, 97.8% to quinolones, and 90-100% to third generation cephalosporins and imipenems. The patients most commonly infected had solid tumors and the mortality was only 17%.
authors.affiliation: Department of Medicine, School of Public Health, University of Trnava, Slovak Repulbic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Krcmery
authors.forename: Stanislav
authors.initials: S
authors.lastname: Spanik
authors.forename: Mariana
authors.initials: M
authors.lastname: Mrazova
authors.forename: Jan
authors.initials: J
authors.lastname: Trupl
authors.forename: Silvia
authors.initials: S
authors.lastname: Grausova
authors.forename: Eva
authors.initials: E
authors.lastname: Grey
authors.forename: Eva
authors.initials: E
authors.lastname: Kukuckova
authors.forename: Margita
authors.initials: M
authors.lastname: Sulcova
authors.forename: Iveta
authors.initials: I
authors.lastname: Krupova
authors.forename: Pavol
authors.initials: P
authors.lastname: Koren
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents