Highlights
- •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.
Background
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.
Methods
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.
Results
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.
Discussion/Conclusions
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.
Key Words
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Article Info
Publication History
Published online: May 26, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
