Microbiology and prevalence of E2SKAPE-resistant strains in catheter-related bloodstream infections in patients with cancer

Introduction: Central venous catheters (CVCs) are essential for treating cancer patients, but infection is a risk associated with their use, particularly by multidrug-resistant (MDR) bacteria. The aim of this study was to describe the microbiology of catheter-related bloodstream infections (CRBSIs) in cancer patients and to compare the prevalence of MDR ESKAPE microorganisms (Enterococcus faecium, Staphylococcus spp, Klebsiella spp, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp) plus Escherichia coli (E(2)SKAPE). Methods: Based on data from 2013 to 2015 from a prospective survey of CRBSIs by the intravenous therapy team, we describe the microbiology and compare the prevalence of MDR E(2)SKAPE strains between hospitalized patients and outpatients. Results: A total of 469 episodes of CRBSI were diagnosed: 261 (62%) were in women; 87 (18.6%) occurred in hospitalized patients, and 382 (81.4%) in ambulatory patients; 27.5% of patients had a hematologic malignancy and 72.5% a solid tumor. The median time between CVC insertion and CRBSI was 116 days (interquartile range [IQR], 48-207). The most common bacteria isolated were Staphylococcus epidermidis (18.1%), S aureus (10.9%), E coli (7.7%), and Klebsiella spp (8.6%). E(2)SKAPE accounted for 35.6%. Methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 16.4; 95% confidence interval [CI], 1.6-114; P= .01), extended-spectrum beta-lactamase (ESBL) Klebsiella spp (OR, 26; 95% CI, 2-286; P= .007), and ESBL E coli (OR, 26; 95% CI, 2-286; P = .007) were significantly more frequently isolated from hospitalized vs ambulatory patients. Conclusions: MRSA, ESBL E. coli and ESBL Klebsiella spp were significantly more frequently isolated from hospitalized patients with CRBSI. (C) 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.