title: Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the impact of fecal extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) colonization for bloodstream infection (BSI), clinical outcome, and costs in patients with hematologic malignancies (HM) and severe neutropenia.
  
  
  METHODS
  This is a cohort study, carried out at a cancer-referral hospital. The study population comprises patients with HM, hospitalized prior to administration of the first chemotherapy cycle. A stool culture was taken during the first 48 h; they were grouped as colonized by ESBL-EC or non-ESBL-EC. Patients were followed upon completion of chemotherapy or death. The sum of the days of antibiotics and the length of stay of all hospitalizations in the different cycles of chemotherapy were recorded.
  
  
  RESULTS
  We included 126 patients with a recent diagnosis of HM, grouped as 63 patients colonized by ESBL-EC and 63 colonized by non-ESBL-EC, aged 42 ± 16 years old, 78 males (62%). BSI by ESBL-EC developed in 14 patients (22.2%) colonized by the same strain and in 5 (7.9%) in the group colonized with non-ESBL-EC. BSI by non-ESBL-EC was observed in 3 patients (4.7%) colonized by ESBL-EC and in 17 (26.9%) patients colonized by non-ESBL-EC. Colonization with ESBL-EC increased the risk of BSI by the same strain (relative risk (RR) = 3.4, 95% confidence interval (95% CI) 1.5-7.8, p = 0.001), shorter time to death (74 ± 62 vs. 95 ± 83 days, p < 0.001), longer hospital stay (64 ± 39 vs. 48 ± 32 days, p = 0.01), and higher infection-related costs ($6528 ± $4348 vs. $4722 ± $3173, p = 0.01). There was no difference in overall mortality between both groups.
  
  
  CONCLUSIONS
  Fecal colonization by ESBL-EC is associated with increased risk of BSI by this strain, longer hospital stay, and higher related costs.
authors.affiliation: Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, Mexico City, DF, Mexico. patcornejo@yahoo.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cornejo-Juárez
authors.affiliation: Division of Clinical Research, "20 de Noviembre," National Medical Center, ISSSTE, Mexico City, Mexico.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Suárez-Cuenca
authors.affiliation: Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, Mexico City, DF, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Volkow-Fernández
authors.affiliation: Departamento de Diagnóstico Epidemiológico, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Silva-Sánchez
authors.affiliation: Departamento de Diagnóstico Epidemiológico, Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico.
authors.forename: Humberto
authors.initials: H
authors.lastname: Barrios-Camacho
authors.affiliation: INSP, Cuernavaca, Morelos, Mexico.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Nájera-León
authors.affiliation: Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, Mexico City, DF, Mexico.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Velázquez-Acosta
authors.affiliation: Department of Infectious Diseases, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14000, Mexico City, DF, Mexico.
authors.forename: Diana
authors.initials: D
authors.lastname: Vilar-Compte
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology; D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000209:etiology* / Q000401:mortality; D005243:Feces / Q000382:microbiology*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
keywords: Bloodstream infection; Colonization; Escherichia coli; Extended-spectrum β-lactamase; Mortality