title: Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies.
abstract: OBJECTIVE
  To identify risk factors for mortality in patients suffering from hematological malignancies with concurrent bacteremia caused by Escherichia coli. Particular attention was focused on defining the impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance by the bacterial isolates on mortality.
  
  
  METHODS
  A retrospective eight-year cohort study design was employed. The outcome measured was death within 30 days of the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality.
  
  
  RESULTS
  A total of 62 episodes of bacteremia caused by E. coli were analyzed. The overall incidences of ESBL production and fluoroquinolone resistance were 41.9% and 62.9%, respectively. The overall 30-day mortality rate was 20.9% (13/62). In a multivariate analysis, significant predictors of mortality were inadequate initial antimicrobial therapy (OR=14.96, 95% CI 1.95-114.51; P=0.009), infection caused by ESBL-producing isolates (OR=8.84, 95% CI 1.48-52.91; P=0.01), and prolonged neutropenia (OR=8.10, 95% CI 1.29-50.57; P=0.02).
  
  
  CONCLUSIONS
  Sound knowledge of the local distribution of pathogens and their susceptibility patterns and prompt initiation of effective antimicrobial treatment are essential in patients suffering from hematological malignancies with BSIs caused by E. coli.
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Trecarichi
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.forename: Teresa
authors.initials: T
authors.lastname: Spanu
authors.forename: Morena
authors.initials: M
authors.lastname: Caira
authors.forename: Luana
authors.initials: L
authors.lastname: Fianchi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Chiusolo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fadda
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leone
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D016009:Chi-Square Distribution; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D019337:Hematologic Neoplasms / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D024841:Fluoroquinolones; D001618:beta-Lactamases