title: Bacteraemia caused by Escherichia coli in cancer patients at a specialist center in Pakistan.
abstract: OBJECTIVE
  To analyse the antimicrobial susceptibility patterns of Escherichia coli bacteraemia among cancer patients, and to assess the risk factors and outcomes of multidrug-resistant Escherichia coli bacteraemia.
  
  
  METHODS
  The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and comprised medical records of patients with Escherichia coli bacteraemia presenting between December 2012 and November 2013. Multivariable logistic regression analyses were used to determine the factors associated with the development and 30-day mortality of multidrug-resistant Escherichia coli bacteraemia.
  
  
  RESULTS
  Out of 1603 episodes of bacteraemia, 227(35.6%) were caused by E.coli, of which 98(43.2%) were multidrug-resistant. In multivariable analysis, age less than 18 years (adjusted odds ratio 3.92; 95% confidence interval 1.43-10.68), presence of central venous catheter (adjusted odds ratio 2.12; 95% confidence interval 1.04-4.33) and exposure to piperacillin/tazobactam within 90 days prior to infection (adjusted odds ratio 2.37; 95% confidence interval 1.15-4.86) were identified as independent risk factors for acquisition of multidrug-resistant Escherichia coli bacteraemia. The overall 30 day mortality rate was 35.2% (80/227). Risk factors for mortality were intensive care unit admission (adjusted odds ratio 3.95; 95% confidence interval 1.79-8.71) and profound neutropenia (adjusted odds ratio 4.03; 95% confidence interval 1.55-10.49).
  
  
  CONCLUSIONS
  Bloodstream infections with multidrug-resistant Escherichia coli were common in cancer patients. However it was not a predictor of mortality.
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Azra
authors.initials: A
authors.lastname: Parveen
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Faisal
authors.initials: F
authors.lastname: Sultan
authors.affiliation: Department of Internal Medicine, Sharif Medical and Dental College, Lahore, Pakistan.
authors.forename: Aun
authors.initials: A
authors.lastname: Raza
authors.affiliation: Department of Cancer Registry, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Waleed
authors.initials: W
authors.lastname: Zafar
authors.affiliation: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Summiya
authors.initials: S
authors.lastname: Nizamuddin
authors.affiliation: Department of Internal Medicine, Bacha Khan Medical Complex, Swabi, Pakistan.
authors.forename: Amjad
authors.initials: A
authors.lastname: Mahboob
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Saliha
authors.initials: S
authors.lastname: Saleem
authors.affiliation: Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Syed Hammad
authors.initials: SH
authors.lastname: Nazeer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy; D002173:Cancer Care Facilities; D002648:Child; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000382:microbiology*; D010154:Pakistan; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Escherichia coli, Bacteraemia, Multidrug resistant, Cancer.