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


CONCLUSIONS
This review gives a complete overview on the management of ESBL-E in the high-risk setting.
a 1st Department of Internal Medicine , University of Cologne , Cologne , Germany .
Lena M
LM
Biehl
b Klinik für Hämatologie, Onkologie und Tumorimmunologie , HELIOS Klinikum Berlin Buch , Berlin , Germany .
Martin
M
Schmidt-Hieber
a 1st Department of Internal Medicine , University of Cologne , Cologne , Germany .
Blasius
B
Liss
a 1st Department of Internal Medicine , University of Cologne , Cologne , Germany .|c German Centre for Infection Research at Cologne , Germany , and.|d Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, and Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne , Cologne , Germany.
Oliver A
OA
Cornely
a 1st Department of Internal Medicine , University of Cologne , Cologne , Germany .|c German Centre for Infection Research at Cologne , Germany , and.
Maria J G T
MJ
Vehreschild
D016470:Bacteremia; D003428:Cross Infection; D019468:Disease Management; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D063868:Patient Outcome Assessment; D015995:Prevalence; D012306:Risk; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
D001618:beta-Lactamases
Bloodstream infection; ESBL; ICU; colonization; malignancy; neutropenia