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Carbapenem Resistant Enterobacteriaceae, Hematological Malignancies, Acute Myeloid Leukemia, Colonization, Mortality


Background: Gut colonisation with Carbapenem Resistant Enterobacteriaceae (CRE) is a risk factor for CRE bacteremia and patients with haematological malignancies (HM) are at the highest risk of mortality.

Methods: We conducted a prospective surveillance study of gut colonisation with CRE and its impact on the outcome on  225 consecutive patients of HM over 28 months.                                                                                                                                                                                                                                                                                                                   Results: The median age of the cohort was 46 years, majority with Acute Leukemia.  48 (21%) patients were colonized with CRE on admission (CAD). Another 46 patients were colonized with CRE in the hospital (CIH). The risk factors for CAD and CIH were diagnosis of acute leukemia and duration of hospital stay respectively. CRE accounted for 77% of non-relapse mortality (NRM). CRE bacteremia occurred only in colonized patients with 100% mortality. NRM was 35.3% in CIH group compared to 10.5% in the CAD group (p=0.0001). NRM was highest in those with AML and CIH (54.9% p=0.0001). On multivariate analysis, CIH was the most important risk factor for NRM (HR-7.2).

Conclusion: Our data demonstrates that a substantial proportion of patients with HM are colonized with CRE without prior hospitalization, but those with nosocomial colonization have the highest risk of mortality, particularly in those with Acute Myeloid Leukemia.


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1. Davies J, Davies D: Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev 2010, 74(3):417-433.
2. Satlin MJ, Jenkins SG, Walsh TJ: The global challenge of carbapenem-resistant Enterobacteriaceae in transplant recipients and patients with hematologic malignancies. Clin Infect Dis 2014, 58(9):1274-1283.
3. Gupta N, Limbago BM, Patel JB, Kallen AJ: Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011, 53(1):60-67.
4. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S et al: Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis 2010, 10(9):597-602.
5. Saseedharan S, Sahu M, Pathrose EJ, Shivdas S: Act Fast as Time Is Less: High Faecal Carriage of Carbapenem-Resistant Enterobacteriaceae in Critical Care Patients. J Clin Diagn Res 2016, 10(9):DC01-DC05.
6. Falagas ME, Lourida P, Poulikakos P, Rafailidis PI, Tansarli GS: Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae: systematic evaluation of the available evidence. Antimicrob Agents Chemother 2014, 58(2):654-663.
7. Montagnani C, Prato M, Scolfaro C, Colombo S, Esposito S, Tagliabue C, Lo Vecchio A, Bruzzese E, Loy A, Cursi L et al: Carbapenem-resistant Enterobacteriaceae Infections in Children: An Italian Retrospective Multicenter Study. Pediatr Infect Dis J 2016, 35(8):862-868.
8. Zhang R, Liu L, Zhou H, Chan EW, Li J, Fang Y, Li Y, Liao K, Chen S: Nationwide Surveillance of Clinical Carbapenem-resistant Enterobacteriaceae (CRE) Strains in China. EBioMedicine 2017, 19:98-106.
9. Caselli D, Cesaro S, Fagioli F, Carraro F, Ziino O, Zanazzo G, Meazza C, Colombini A, Castagnola E, Infectious Diseases Study Group of the Italian Association of Pediatric H et al: Incidence of colonization and bloodstream infection with carbapenem-resistant Enterobacteriaceae in children receiving antineoplastic chemotherapy in Italy. Infect Dis (Lond) 2016, 48(2):152-155.
10. Micozzi A, Gentile G, Minotti C, Cartoni C, Capria S, Ballaro D, Santilli S, Pacetti E, Grammatico S, Bucaneve G et al: Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias. BMC Infect Dis 2017, 17(1):203.
11. CLSI: Performance Standards for Antimicrobial Susceptibility Testing. In: Enterobacteriaceae. Clinical and laboratory Standard Institute; 2016: 52-59.
12. Cohen Stuart J, Leverstein-Van Hall MA, Dutch Working Party on the Detection of Highly Resistant M: Guideline for phenotypic screening and confirmation of carbapenemases in Enterobacteriaceae. Int J Antimicrob Agents 2010, 36(3):205-210.
13. Bakthavatchalam YD, Anandan S, Veeraraghavan B: Laboratory Detection and Clinical Implication of Oxacillinase-48 like Carbapenemase: The Hidden Threat. J Glob Infect Dis 2016, 8(1):41-50.
14. Datta P, Gupta V, Singla N, Chander J: Asymptomatic colonization with carbapenem resistant enterobacteriaceae (CRE) in ICU patients and its associated risk factors: Study from North India. Indian J Med Microbiol 2015, 33(4):612-613.
15. Rai S, Das D, Niranjan DK, Singh NP, Kaur IR: Carriage prevalence of carbapenem-resistant Enterobacteriaceae in stool samples: A surveillance study. Australas Med J 2014, 7(2):64-67.
16. Pouch SM, Satlin MJ: Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies. Virulence 2017, 8(4):391-402.
17. Rodrigues Perez LR: Carbapenem-Resistant Enterobacteriaceae: A Major Prevalence Difference due to the High Performance of Carbapenemase Producers when compared to the Nonproducers. Infect Control Hosp Epidemiol 2015, 36(12):1480-1482.
18. Satlin MJ, Cohen N, Ma KC, Gedrimaite Z, Soave R, Askin G, Chen L, Kreiswirth BN, Walsh TJ, Seo SK: Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies. J Infect 2016, 73(4):336-345.
19. Schwartz-Neiderman A, Braun T, Fallach N, Schwartz D, Carmeli Y, Schechner V: Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients. Infect Control Hosp Epidemiol 2016, 37(10):1219-1225.
20. Swaminathan M, Sharma S, Poliansky Blash S, Patel G, Banach DB, Phillips M, LaBombardi V, Anderson KF, Kitchel B, Srinivasan A et al: Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013, 34(8):809-817.
21. van Loon K, Voor In 't Holt AF, Vos MC: Clinical epidemiology of carbapenem-resistant Enterobacteriaceae: a systematic review and meta-analyses. Antimicrob Agents Chemother 2017.
22. Weber DJ, Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE: Carbapenem-resistant Enterobacteriaceae: frequency of hospital room contamination and survival on various inoculated surfaces. Infect Control Hosp Epidemiol 2015, 36(5):590-593.
23. Bar-Yoseph H, Hussein K, Braun E, Paul M: Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother 2016, 71(10):2729-2739.
24. Manoharan A, Barla GS, Peter R, Sugumar M, Mathai D: Multidrug resistance mediated by co-carriage of extended-spectrum beta-lactamases, AmpC and New Delhi metallo-beta-lactamase-1 genes among carbapenem-resistant Enterobacteriaceae at five Indian medical centres. Indian J Med Microbiol 2016, 34(3):359-361.
25. Chen L, Kreiswirth BN: Convergence of carbapenem-resistance and hypervirulence in Klebsiella pneumoniae. Lancet Infect Dis 2017.
26. Khare V, Gupta P, Haider F, Begum R: Study on MICs of Tigecycline in Clinical Isolates of Carbapenem Resistant Enterobacteriaceae (CRE) at a Tertiary Care Centre in North India. J Clin Diagn Res 2017, 11(3):DC18-DC21.
27. Kumar M: Colistin and Tigecycline Resistance in Carbapenem-Resistant Enterobacteriaceae: Checkmate to Our Last Line Of Defense. Infect Control Hosp Epidemiol 2016, 37(5):624-625.
28. Pogue JM, Marchaim D, Abreu-Lanfranco O, Sunkara B, Mynatt RP, Zhao JJ, Bheemreddy S, Hayakawa K, Martin ET, Dhar S et al: Fosfomycin activity versus carbapenem-resistant Enterobacteriaceae and vancomycin-resistant Enterococcus, Detroit, 2008-10. J Antibiot (Tokyo) 2013, 66(10):625-627.
29. Poirel L, Kieffer N, Liassine N, Thanh D, Nordmann P: Plasmid-mediated carbapenem and colistin resistance in a clinical isolate of Escherichia coli. Lancet Infect Dis 2016, 16(3):281.
30. Livermore DM, Warner M, Mushtaq S, Doumith M, Zhang J, Woodford N: What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents 2011, 37(5):415-419.
31. Rieg S, Kupper MF, de With K, Serr A, Bohnert JA, Kern WV: Intestinal decolonization of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL): a retrospective observational study in patients at risk for infection and a brief review of the literature. BMC Infect Dis 2015, 15:475.
32. Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R: Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 2014, 14(8):742-750.