title: Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies.
abstract: To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies.
  
  
  
  We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case.
  
  
  
  CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior β-lactam/β-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08).
  
  
  
  CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population.
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA. Electronic address: mjs9012@med.cornell.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Satlin
authors.affiliation: Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: cohenn@mskcc.org.
authors.forename: Nina
authors.initials: N
authors.lastname: Cohen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA. Electronic address: kcm9006@nyp.org.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ma
authors.affiliation: Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: gedrimaz@mskcc.org.
authors.forename: Zivile
authors.initials: Z
authors.lastname: Gedrimaite
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA. Electronic address: rsoave@med.cornell.edu.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Soave
authors.affiliation: Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. Electronic address: gua2004@med.cornell.edu.
authors.forename: Gülce
authors.initials: G
authors.lastname: Askin
authors.affiliation: Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address: chen11@njms.rutgers.edu.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, USA. Electronic address: kreiswba@njms.rutgers.edu.
authors.forename: Barry N
authors.initials: BN
authors.lastname: Kreiswirth
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA; Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA; Department of Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA. Electronic address: thw2003@med.cornell.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.affiliation: Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: seos@mskcc.org.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Seo
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology*; D015780:Carbapenems / Q000494:pharmacology; D016022:Case-Control Studies; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Bacteremia; Carbapenem-resistant Enterobacteriaceae; Hematologic malignancies; Neutropenic patients; Outcomes; Prevalence; Risk factors