title: Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients.
abstract: We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2-365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5-14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3-4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA. Electronic address: ahess@epi.umaryland.edu.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Hess
authors.affiliation: Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kleinberg
authors.affiliation: Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, University of Maryland School of Medicine, Baltimore, MD, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Sorkin
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.affiliation: Department of Pathology, University of Maryland, Baltimore, MD, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Johnson
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA. Electronic address: mroghman@epi.umaryland.edu.
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Neutropenic fever; Surveillance cultures