Multidrug-resistant Escherichia coli bacteremia in cancer patients
published online 01 June 2009.
Background
Multidrug-resistant (MDR) Escherichia coli is a serious threat to cancer patients. We aimed to determine the risk factors associated with the development of MDR E coli bacteremia in cancer patients and the possibility of horizontal transmission.
Methods
We conducted a 1:2 case-control study of 58 patients with MDR E coli bacteremia. The patient's demographics, clinical characteristics, and antibiotic use were obtained. MDR E coli was defined as resistant strains to quinolones plus 1 of the following: piperacillin, ceftazidime, or cefepime. Repetitive sequence-based polymerase chain reaction (Rep-PCR) was used to identify DNA interstrain similarities.
Results
Conditional multiple logistic analysis showed that admission to the hospital within the 30 days prior to infection and chemotherapy use were risk factors for infection with MDR E coli. Rep-PCR showed that, among the MDR E coli strains recovered, 48.6% showed >95% similarity, representing a possible clonal outbreak. Infection control measures were implemented and controlled this horizontal transmission.
Conclusion
Prior admission to the hospital and previous chemotherapy were independent risk factors of acquiring MDR E coli. Molecular fingerprinting techniques detected a possible nosocomial clonal outbreak of MDR E coli, which was aborted through infection control measures.
aUniversity of Texas at Houston-Medical School, Houston, TX
bUniversity of Texas-M.D. Anderson Cancer Center, Houston, TX
Address correspondence to Javier A. Adachi, MD, 1400 Pressler, Unit 1460, Houston, TX 77030.
Supported by discretionary funds, with no external or private financial support. KJV and JAA contributed equally to this work.
An abstract version of this paper was presented at the 45th Annual Meeting of the Infectious Diseases Society of America (IDSA) on October 2007.
ABSTRACT