Open Access479. Associated Factors for Extended-Spectrum β-Lactamase Infection Among Patients with Solid or Hematological Malignancy
Author(s) -
Álvaro José Martínez-Valencia,
B Ricardo Martínez,
Anita M Montañez Ayala,
Katherine García,
Ricardo Sanchéz Pedraza,
Leydy Paola Jiménez Cetina,
Sonia Isabel Cuervo,
Julio César Gómez-Rincón
Publication year - 2019
Publication title -
open forum infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.546
H-Index - 35
ISSN - 2328-8957
DOI - 10.1093/ofid/ofz360.552
Subject(s) - medicine , neutropenia , enterobacteriaceae , klebsiella pneumoniae , chemotherapy , antibiotics , medical record , infection control , logistic regression , malignancy , surgery , microbiology and biotechnology , escherichia coli , biochemistry , chemistry , biology , gene
Background Cancer patients are susceptible to infections due to immunodeficiency, frequent invasive interventions-devices, chemotherapy and antibiotics exposure. Infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae increase morbidity and mortality. The objective was to identify clinical factors associated with ESBL in infected patients with cancer at the Instituto Nacional de Cancerología. Methods A case–control study was conducted from 2013 to 2015. Cases were infected patients with ESBL-producer Enterobacteriaceae. Controls (matched for date and ward) with non-ESBL-producer Enterobacteriaceae were included. Data were extracted from electronic medical records at index culture: clinical and admission data, Charlson index, immunosuppressive, radio and chemotherapy, neutropenia, invasive devices, surgical procedures and antimicrobial therapy. Microorganisms were identified by the automatized system. Conditional logistic regression and backward stepwise was used to identify predictors of ESBL isolation. Results A total of 265 patients with ESBL producer Enterobacteriaceae and 445 non-ESBL producers were identified, mean age 59, 61% male, 48% admitted as outpatients, 73% with solid tumors, 38% with Charlson index ≥4. E.coli and Klebsiella spp. represented 90% of microorganisms. Factor associated with ESBL producer Enterobacteriaceae were hospitalization ≥7 days (OR: 1,59; CI 1.11–2,29), hospitalization the previous year (OR: 4.02; CI 2,68–6,02), immunosuppressive therapy (OR: 2.07; CI 1,05–4.05), Β-lactam therapy the last month (OR: 1.54; CI 1.05–2.26), invasive devices (OR: 1.58; CI 1.10–2.27), active neoplasia (OR: 2,22; CI1.05–4.68), neutropenia (OR: 2.03; CI:1.26–3.27) and absence of chemotherapy during last 3 months (OR: 1.91; CI1.29–2.82). Discriminatory capacity was acceptable (AUC: 0.71). Conclusion The presence of ESBL-producer Enterobacteriaceae in oncologic patients is associated with health care, hospital admission and length of stay, invasive devices and exposure to antibiotics. The magnitude of associated factors are weak and do not completely allow the identification of cancer patients infected with ESBL-producer Enterobacteriaceae. Disclosures All authors: No reported disclosures.