Detection of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) among patients with acute myeloid leukemia and lymphoma upon admission to hospital

The aim of the study was to evaluate colonization with ESBL-E of gut and oropharynx in patients with acute myeloid leukemia (AML) and lymphoma before the start of the chemotherapy. 98 patients (33 with AML and 65 with lymphoma) were included in the prospective study (2013–2014). Newly diagnosed hematological malignancies were in 94 (96%) patients. Median age of patients with lymphoma and AML was 47 and 35 years. For the first two days after admission to the hospital swabs from gut and oropharynx in patients were taken. ESBL production was confirmed by phenotypic tests, the genes bla_CTX-M and bla_TEM - by real-time PCR. Upon admission to the hospital ESBL-E colonization of gut was detected in 27% patients (28% in AML and 24% in lymphoma) and only 4% patients had ESBL-E colonization of throat, p < 0,01. Total of 34 of ESBL-E isolates were detected (E. coli 52%, K. pneumonia 42%, Citrobacter spp. 6%). CTX-M type ESBL was detected in 76% of isolates, TEM type – in 53%, coexistence of TEM and CTX-M – in 44%. Independent risk factors for ESBL-E colonization in patients with lymphoma were transfer from another hospital (OR 4,2; p = 0,01) and age from 50 years and older (OR 3,0; p = 0.05); in patients with AML – place of living outside of Moscow (OR 7,6; p = 0,04). Multivariate analysis showed the same risk factors. Our results make doubtful the prescription of fluoroquinolones for prophylaxis without prior screening. Prophylaxis with fluoroquinolones may be optimal only for patients without ESBL-E colonization.

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