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Cited by 77Antibiotic Resistance in BacteriaNeutropenia and Cancer InfectionsUrinary Tract Infections Management

Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae and risk for infection among patients with solid or haematological malignancy: a systematic review and meta-analysis

Alevizakos, Michail, Karanika, Styliani, Detsis, Marios, Mylonakis, Eleftherios·2016·International Journal of Antimicrobial Agents
DOI 10.1016/j.ijantimicag.2016.08.021
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Abstract

Cancer patients are vulnerable to infections, including those with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), and most of these infections are associated with colonisation of the gastrointestinal tract. The aim of this study was to estimate the prevalence of gastrointestinal colonisation with ESBL-PE cancer populations and to determine the risk for subsequent bloodstream infection (BSI) with these pathogens. PubMed and EMBASE databases were searched from 1 January 1991 to 1 March 2016 to identify studies regarding ESBL-PE colonisation among patients with malignancies. Ten studies (out of 561 non-duplicate articles) were included, providing data on 2211 patients. The pooled prevalence of ESBL-PE colonisation was 19% [95% confidence interval (CI) 8-32%]. Stratifying per region, the pooled prevalence in Europe was 15% (95% CI 10-21%), whereas in Asia the pooled prevalence was 31% (95% CI 4-69%). In addition, the pooled prevalence was 15% (95% CI 7-24%) among patients with haematological malignancy, whereas no studies were identified that included solely patients with solid tumours. Notably, cancer patients with ESBL-PE colonisation were 12.98 times (95% CI 3.91-43.06) more likely to develop a BSI with ESBL-PE during their hospitalisation compared with non-colonised patients. We found that, overall, one in five patients with cancer is colonised with ESBL-PE and the incidence can be as high as one in three in Asia. This is important because colonisation was associated with an almost 13 times higher risk for developing BSI with ESBL-PE. Screening measures should be evaluated to identify their clinical benefit in patients with malignancy.

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  • Factors guiding double gram-negative coverage include proven infection or colonisation with resistant organisms in the prior year, local prevalence, hospital-acquired/healthcare-associated infection, broad-spectrum antibiotics in prior 90 days, concurrent SDD, travel to a highly endemic country in prior 90 days, and hospitalisation abroad in prior 90 days.

    “Factors to guide this decision include: proven infection or colonisation with antibiotic-resistant organisms within the preceding year, local prevalence of antibiotic-resistant organisms, hospital-acquired/healthcare associated (versus community-acquired infection), broad-spectrum antibiotic use within the preceding 90 days”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [162]

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Authors
Alevizakos, M., Karanika, S., Detsis, M., & Mylonakis, E.
Affiliations
Brown University (US)
Corresponding author
Mylonakis, Eleftherios
ORCID
Venue
International Journal of Antimicrobial Agents
Publisher
Elsevier BV
Published
2016-12
Volume
48
Issue
6
Pages
647-654
ISSN
0924-8579 (ISSN-L)
DOI
10.1016/j.ijantimicag.2016.08.021
OpenAlex
W2529736552
Cited by
77
References
38
Citations by year
2026: 15 · 2025: 8 · 2024: 7 · 2023: 10 · 2022: 5 · 2021: 11 · 2020: 8 · 2019: 3 · 2018: 2 · 2017: 8
FWCI
0.28
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • International Journal of Antimicrobial Agents (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
Keywords
extended-spectrum beta-lactamase, ESBL-producing Enterobacteriaceae, bloodstream infection, cancer patients, hematologic malignancies, solid tumors, prevalence, infection risk, antimicrobial resistance, screening
MeSH terms
Asia, beta-Lactamases, Carrier State, Enterobacteriaceae, Enterobacteriaceae Infections, Europe, Humans, Neoplasms, Prevalence, Bacteremia, Risk Assessment

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