Extended spectrum cephalosporin resistant enterobacteriaceae carriage and infection in patients admitted with newly-diagnosed acute leukemia


      • Carriage of cephalosporin-resistant Enterobacteriaceae is common in acute leukemia.
      • Hospital acquired carriage is more common in AML than ALL.
      • Cephalosporin-resistant genera express differing resistance genes and antibiotic sensitivities.


      Current information is limited on the incidence, risk factors, and consequences of extended-spectrum cephalosporin resistant Enterobacteriaceae (ESCRE) carriage in patients undergoing therapy for newly-diagnosed acute leukemia.


      We monitored 300 consecutive patients who submitted a first stool within the first week of initial hospitalization for initial and hospital acquired ESCRE carriage. Selected available isolates underwent DNA sequencing for determination of strain typing and resistance genes.


      19 (6%) patients had ESCRE in their initial stool, and there was continued risk for new acquisition throughout their multiple hospitalizations. Patients with AML had more acquired carriage during their initial hospitalization. Increased hospitalizations and male sex were risk factors for detected acquired ESCRE carriage. ESCRE stool carriage was predictive for ESCRE BSI but not for overall survival. Sequencing revealed that E. coli ESCRE isolates contained primarily ESBL, while Enterobacter spp. and Citrobacter spp. showed primarily AmpC genes. The antibiotic sensitivity patterns for ESCRE BSI isolates reflected these genome findings.


      ESCRE carriage is common in patients with acute leukemia undergoing repeated hospitalizations and increases the risk for ESCRE BSI. ESCRE genera express differing resistance genes which may be predictive for empiric antibiotic efficacy.

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        • Cornejo-Juarez P
        • Perez-Jimenez C
        • Silva-Sanchez J
        • et al.
        Molecular analysis and risk factors for Escherichia coli producing extended-spectrum β-lactamase bloodstream infection in hematological malignancies.
        PLoS One. 2012; 7: e35780
        • Trecarichi EM
        • Tumbarello M
        • Spanu T
        • et al.
        Incidence and clinical impact of extended-spectrum-β-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies.
        J Infect. 2009; 58: 299-307
        • Trecarichi EM
        • Tumbarello M.
        Antimicrobial-resistant gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact.
        Curr Opin Infect Dis. 2014; 27: 200-210
        • Kim Y-J
        • Jung SM
        • Kang J
        • et al.
        Risk factors for extended-spectrum beta-lactamase-producting Enterobacteriaceae infection causing septic shock in cancer patients with chemotherapy-induced febrile neutropenia.
        Intern Emerg Med. 2019; 14: 433-440
        • Cattaneo C
        • Di Blasi R
        • Skert C
        • et al.
        Bloodstream infections in haematological cancer patients colonized by multifrut-resistant bacteria.
        Ann Hematol. 2018; 97: 1717-1726
        • Van Duijkeren E
        • Wielders CCH
        • Dierikx CM
        • et al.
        Long-term carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in the general population in the Netherlands.
        Clin Infect Dis. 2018; 66: 1368-1376
        • Islam S
        • Selvarangan R
        • Kanwar N
        • et al.
        Intestinal carriage of third-generation cephalosporin-resistant and extended-spectrum β-lactamase-producing Enterobacteriaceae in healthy US children.
        J Ped Infect Dis Soc. 2018; 7: 234-240
        • Biehl LM
        • Schmidt-Hieber M
        • Liss B
        • et al.
        Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients—Review of the literature from a clinical perspective.
        Crit Rev Microbiol. 2016; 42: 1-16
        • Lim SMS
        • Wong PL
        • Sulaiman H
        • et al.
        Clinical prediction models for ESBL-Enterobacteriaceae colonization or infection: a systematic review.
        J Hosp Infect. 2019; 102: 8-16
        • Arnan M
        • Gudiol C
        • Calatayud L
        • et al.
        Risk factors for, and clinical relevance of, faecal extended-spectrum β-lactamase producing Escherichia coli (ESBL-EC) carriage in neutropenic patients with haematological malignancies.
        Eur J Clin Microbiol Infect Dis. 2011; 30: 355-360
        • Prevel R
        • Boyer A
        • M'Zali F
        • et al.
        Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review.
        Crit Care. 2019; 23: 170
        • Cornejo-Juarez P
        • Suarez-Cuenca JA
        • Volkow-Fernandez P
        • et al.
        Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies.
        Supp Care Cancer. 2016; 24: 253-259
        • Prevel R
        • Boyer A
        • M'Zali F
        • et al.
        Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection.
        Antimicrob Resist Infect Control. 2019; 8: 112
        • Bradford PA
        Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat.
        Clin Microbiol Rev. 2001; 14: 933-951
        • den Reijer PM
        • van Burgh S
        • Burggraaf A
        • et al.
        The widespread presence of a multidrug-resistant Escherichia coli ST 131 clade among community -associated and hospitalized patients.
        PLOS One. 2016; 11e0150420
        • Porres-Osante N
        • Saenz Y
        • Somalo S.
        Characterization of Beta-lactamases in Faecal Enterobacteriaceae recovered from healthy humans in Spain: focusing on AmpC polymorphisms.
        Microb Ecol. 2015; 70: 132-140
        • Park SH
        • Byun JH
        • Choi SM
        • et al.
        Molecular epidemiology of extended-spectrum beta-lactamase resistant Escherichia coli in the community and hospital in Korea: emergence of ST131 producing CTX-M-15.
        BMC Infect Dis. 2012; 12: 149
        • Kohlmann R
        • Bahr T
        • Gatermann SG.
        Species-specific mutation rates for ampC derepression in Enterobacterales with chromosomally encoded inducible AmpC β-lactamase.
        J Antimicrobial Chemother. 2018; 73: 1530-1536
        • Tamma PD
        • Doi Y
        • Bonomo RA
        • Johnson JK
        Simner PJ for the antibacterial resistance leadership Group. A primer on AmpC β-lactamases: necessary knowledge for an increasingly multidrug-resistant world.
        Clin Infect Dis. 2019; 69: 1446-1455
        • Sfeir MM
        • Askin G
        • Christos P
        Beta-lactam/beta-lactamase inhibitors vs carbapenem for bloodstream infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: systematic review and meta-analysis.
        Int J Antimicrob Agents. 2018; 52: 554-570
        • Nasir N
        • Ahmed S
        • Razi S
        • et al.
        Risk factors for mortality of patients with ceftriaxone resistant E. coli bacteremia receiving carbapenem vs beta lactam/betalactamase inhibitor therapy.
        BMC Res Notes. 2019; 12: 611