title: Epidemiology, antibiotic therapy and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in cancer patients.
abstract: OBJECTIVE
  Infection due to the six ESKAPE pathogens has recently been identified as a serious emerging problem. However, there is still a lack of information on bacteremia caused by these organisms in cancer patients. We aimed to assess the epidemiology, antibiotic therapy and outcomes of bacteremia due to drug-resistant ESKAPE pathogens (rESKAPE) in patients with cancer.
  
  
  METHODS
  All episodes of bacteremia prospectively documented in hospitalized adults with cancer from 2006 to 2011 were analyzed.
  
  
  RESULTS
  Of 1,148 episodes of bacteremia, 392 (34 %) were caused by ESKAPE pathogens. Fifty-four episodes (4.7 %) were due to rESKAPE strains (vancomycin-resistant Enterococcus faecium 0, methicillin-resistant Staphylococcus aureus (MRSA) 13, extended-spectrum beta-lactamase (ESLB)-producing Klebsiella pneumoniae 7, carbapenem-resistant Acinetobacter baumannii 4, carbapenem- and quinolone-resistant Pseudomonas aeruginosa 18 and derepression chromosomic ß-lactam and ESBL-producing Enterobacter species 12. Risk factors independently associated with rESKAPE bacteremia were comorbidities, prior antibiotic therapy, urinary catheter and urinary tract source. Inappropriate empirical antibiotic therapy was more frequent in patients with rESKAPE bacteremia than in the other cases (55.6 % vs. 21.5 %, p < 0.001). Persistence of bacteremia (25 % vs. 9.7 %), septic metastasis (8 % vs. 4 %) and early case-fatality rate (23 % vs. 11 %) were more frequent in patients with rESKAPE bacteremia than in patients with other etiologies (p < 0.05).
  
  
  CONCLUSIONS
  Bacteremia due to rESKAPE pathogens in cancer patients occurs mainly among those with comorbidities who have received prior antibiotic therapy and have a urinary tract source. These patients often receive inappropriate empirical antibiotic therapy and have a poor outcome.
authors.affiliation: Infectious Disease Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) Research Institute, 08907, L'Hospitalet de Llobregat, Barcelona, Spain, martabodro@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Bodro
authors.forename: Carlota
authors.initials: C
authors.lastname: Gudiol
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.forename: Anna
authors.initials: A
authors.lastname: Contra
authors.forename: Lucía
authors.initials: L
authors.lastname: Boix
authors.forename: Eva
authors.initials: E
authors.lastname: Domingo-Domenech
authors.forename: Mariona
authors.initials: M
authors.lastname: Calvo
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D047090:beta-Lactams / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D047090:beta-Lactams