Clinical Impact of OXA-48-Producing Enterobacterales Rectal Colonization on Hematologic Patients With Febrile Neutropenia
Miguel Rodríguez-Fernández, Pablo Rosales-García, Pedro Martínez Pérez-Crespo, Lucía Valiente-De-Santis, José Luis Cuevas-Corrales, José María San-Emeterio Garrido, Ana Isabel Aller-García, Carmen Serrano-Martino, Marta Trigo-Rodríguez, Rocio Herrero, María Dolores Valverde-Fredet, Antonio Fernández-Pevida, Eva León, Nicolás MerchanteAbstract
Background
The impact of rectal colonization with carbapenemase-producing Enterobacterales (CPE) on subsequent infection and mortality in febrile neutropenia (FN) remains unclear, as does the role of surveillance cultures in guiding empirical therapy. This study assessed the role of colonization and/or infection by OXA-48-producing Enterobacterales (OXA-48-E) on 15-day mortality in hematologic patients with FN.
Method
This single-center retrospective cohort study included hematologic patients receiving chemotherapy, hospitalized for FN, and screened for CPE rectal colonization at admission and weekly. Univariate and multivariate analyses were performed to identify predictors of OXA-48-E infection and 15-day mortality. FN episodes were the analysis unit.
Results
Eighty-seven patients experienced 170 FN episodes (48 in OXA-48-E carriers, 122 in noncarriers). OXA-48-E infection occurred in 15/48 (31%) carrier episodes and in none of the noncarriers, yielding a 100% negative predictive value for recent negative rectal swabs. Other OXA-48-E infection predictors included acute leukemia (aOR 6.71; 95% CI: 1.62–27.77; P = .009), recent carbapenem exposure (aOR 3.37; 95% CI: 1.07-10.61; P = .038) and sepsis/septic shock (aOR 4.26; 95% CI: 1.25–14.48; P = .020).
OXA-48-E infection episodes showed lower rates of active antibiotic therapy within 24 hours (7/15 [47%] vs 128/145 [88%]; P < .001) and higher 15-day mortality (4/15 [27%] vs 5/145 [3%]; P = .005). Independent predictors of mortality were sepsis/septic shock (aOR 18.16; 95% CI: 3.24–101.85; P < .001) and no active antibiotic therapy within 24 hours (aOR 21.68; 95% CI: 2.08–225.63; P = .010).
Conclusions
Rectal colonization strongly predicts OXA-48-E infection in hematologic patients with FN. Furthermore, lack of active antibiotic therapy within the first 24 hours of FN was independently associated with increased mortality.