title: A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies.
abstract: BACKGROUND
  Bloodstream infections (BSIs) caused by enterobacteria remain a leading cause of mortality in patients with chemotherapy-induced neutropenia. The rate and type of colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-E) and their mode of transmission in German cancer centres is largely unknown.
  
  
  METHODS
  We performed a prospective, observational study at five German university-based haematology departments. Participating sites screened for intestinal ESBL-E colonization within 72 h of admission, every 10 ± 2 days thereafter and before discharge. Three of the five centres performed contact isolation for patients colonized or infected with ESBL-E. Molecular characterization of resistance mechanisms and epidemiological typing of isolates by repetitive extragenic palindromic PCR (rep-PCR) and PFGE was performed to assess strain transmission between patients.
  
  
  RESULTS
  Between October 2011 and December 2012, 719 hospitalizations of 497 haematological high-risk patients comprising 20,143 patient-days were analysed. Mean duration of in-hospital stay was 36.6 days (range: 2-159 days). ESBL-E were identified from screening samples (82.8% Escherichia coli and 14.6% Klebsiella pneumoniae) in 55/497 patients (11.1%; range by centre: 5.8%-23.1%). PFGE and rep-PCR revealed only a single case of potential cross-transmission among two patients colonized with K. pneumoniae. Six episodes of BSI with ESBL-E were observed. Multivariate analysis revealed previous colonization with ESBL-E as the most important risk factor for BSI with ESBL-E (OR 52.00; 95% CI 5.71-473.89).
  
  
  CONCLUSIONS
  Even though BSI with ESBL-E is still rare in this high-risk population, colonization rates are substantial and vary considerably between centres. In-hospital transmission of ESBL-E as assessed by molecular typing was the exception.
authors.affiliation: German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany maria.vehreschild@ctuc.de.
authors.forename: Maria J G T
authors.initials: MJ
authors.lastname: Vehreschild
authors.affiliation: German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hamprecht
authors.affiliation: German Centre for Infection Research (DZIF), Germany Med. Klinik III, University of Munich-Campus Großhadern, Munich, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Peterson
authors.affiliation: German Centre for Infection Research (DZIF), Germany Max von Pettenkofer-Institut, University of Munich-Campus Großhadern, Munich, Germany.
authors.forename: Sören
authors.initials: S
authors.lastname: Schubert
authors.affiliation: German Centre for Infection Research (DZIF), Germany Department of Oncology, Haematology, Immunology, Rheumatology and Pulmology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Häntschel
authors.affiliation: German Centre for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Peter
authors.affiliation: German Centre for Infection Research (DZIF), Germany Department of Oncology and Hematology, Hubertus Wald Tumorzentrum/University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Philippe
authors.initials: P
authors.lastname: Schafhausen
authors.affiliation: German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Rohde
authors.affiliation: German Centre for Infection Research (DZIF), Germany Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Germany Klinik für Innere Medizin II-Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany.
authors.forename: Marie V
authors.initials: MV
authors.lastname: Lilienfeld-Toal
authors.affiliation: German Centre for Infection Research (DZIF), Germany Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum Bonn, Bonn, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bekeredjian-Ding
authors.affiliation: German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Libam
authors.affiliation: German Centre for Infection Research (DZIF), Germany Department of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.affiliation: German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jörg J
authors.initials: JJ
authors.lastname: Vehreschild
authors.affiliation: German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN1106, Medical Faculty, University of Cologne, Cologne, Germany Center for Integrated Oncology CIO Köln/Bonn and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany.
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D015331:Cohort Studies; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D055815:Young Adult; D001618:beta-Lactamases / Q000145:classification / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: bacteraemia; bloodstream infections; contact isolation; febrile neutropenia; infection control; intestinal colonization