GUT COLONIZATION WITH CARBAPENEM RESISTANT ENTEROBACTERIACEAE ADVERSELY IMPACTS THE OUTCOME IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES: RESULTS OF A PROSPECTIVE SURVEILLANCE STUDY

SUPARNO CHAKRABARTI

Abstract

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.

Keywords

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

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