Bloodstream infections caused by Escherichia coli in onco-haematological patients: Risk factors and mortality in an Italian prospective survey.

Bloodstream infections (BSIs) remain life-threatening complications in the clinical course of patients with haematological malignancies (HM) and Escherichia coli represent one of the most frequent cause of such infections. In this study, we aimed to describe risk factors for resistance to third generation cephalosporins and prognostic factors, including the impact of third generation cephalosporins resistance, in patients with HM and BSIs caused by E. coli. Three hundred forty-two cases of E. coli BSIs were collected during the study period (from January 2016 to December 2017). The percentage of resistance to third generation cephalosporins was 25.7%. In multivariate analysis, the variables recent endoscopic procedures, culture-positive surveillance rectal swabs for multidrug-resistant bacteria, antibiotic prophylaxis with fluoroquinolones, and prolonged neutropenia were independently associated with bloodstream infections caused by a third generation cephalosporins resistant E. coli. The overall 30-day mortality rate was 7.1%. Cox regression revealed that significant predictors of mortality were acute hepatic failure, septic shock, male sex, refractory/relapsed HM, and third generation cephalosporins resistance by E. coli isolate. In conclusion, resistance to third generation cephalosporins adversely affected the outcomes of bloodstream infections caused by E. coli in our cohort of HM patients. We also found a significant correlation between prophylaxis with fluoroquinolones and resistance to third generation cephalosporins by E. coli isolates.
Competing Interests: EMT has been a speaker at accredited educational courses funded by unrestricted grants from Pfizer and Mattioli 1885. MT has been a scientific advisor/consultant for Angelini, Gilead, MSD, Nordic Pharma, and Roche, and speaker/chairman at accredited educational courses funded by unrestricted grants from Astellas, Gilead, MSD, and Pfizer. LP received honoraria for Advisory Board from Gilead Sciences, MSD, Pfizer, Jazz, Janssen, Menarini and Cidara, and has been speaker for Gilead Sciences, MSD, Pfizer, Celgine, Novartis, Astellas Pharma. MD received honoraria for Advisory Board from Honoraria from MSD, Gilead, and Pfizer. AB received honoraria for Advisory Board from Gilead, Pfizer, MSD, and Jazz. None of the other authors has any conflicts of interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.