Keywords
multidrug-resistant organisms
advanced ovarian cancer
cytoreductive surgery
Abstract
Multidrug-resistant organisms (MDROs) are becoming an increasing problem in hospitals. It is believed that screening patients for the incidence of MDROs prior to hospital admission not only allows for the proper management of infection following medical procedures, but can also potentially reduce the transmission of these bacteria to other patients.
The aim of this study was to assess the carriers of selected MDROs in the gastrointestinal tract among patients with advanced ovarian cancer admitted to the hospital for cytoreductive surgery and to estimate the possible relationship between rectal colonization with these organisms and nosocomial infections.
From December 2013 to May 2014, we evaluated the colonization with VRE (vancomycin-resistant Enterococcus), E. coli KPC+ (class A carbapenemase producing Escherichia coli),E. coli MBL+ (class B carbapenemase, metallo-ß lactamase producing Escherichia coli), and E. coli ESBL+ (extended-spectrum ß-lactamase producing Escherichia coli) in 42 patients. The patients were divided into two subgroups corresponding to the extent of their surgery: the first subgroup consisted of patients with large bowel resection (n=18) and the second subgroup of patients without resection (n=24). A rectal swab was taken within 24 hours of admission. Perioperative infectious complications were analyzed for the first 90 days following surgery with regard to the type of infection and the occurrence of examined MDROs.
In our study, 2.4 % of all patients (23.8/1,000 hospitalizations) were colonized with ESBL - producing Escherichia coli: 0.0 % in the first subgroup and 4.2% in the second subgroup, respectively. We did not identify any patients who were colonized with VRE, E. coli MBL+, or E. coli KPC+. Surgical site infections were seen in 8 (19.1%) out of 42 patients. We were, therefore, unable to confirm a relationship between MDROs colonizing the large bowel and the etiological agents of perioperative infections. However, despite the lack of identification of MDROs as etiological agents of postoperative infection, the risk of serious infectious complications, combined with the changing epidemiological situation, means that microbiological monitoring should be performed in patients with ovarian cancer before and after cytoreductive surgery.
References
1. Gersetein CG, Damhuis RAM, de Vries M, Reedijk A, Burger CW, Kooi GS. Causes of postoperative mortality after surgery for ovarian cancer. Eur J Cancer. 2009;45:2799-803.
2. Chi DS, Eisenhauer EL, Zivanovic O, SonodaY, Abu-Rustum NR, Levine DA, et al. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol Oncol. 2009;114:26-31.
3. Capone A, Valle M, Proietti F, Federici O, Garofalo A, Petrosillo N. Postoperative infections in cytoreductive surgery with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis. J Surg Oncol. 2007;96:507-13.
4. Dazza M, Schwarz L, Coget J, Frebourg N, Wood G, Huet E, et al. Does intraoperative systematic bacterial sampling during complete cytoreductive surgery (CRS) with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) inf luence postoperative treatment? A new predictive factor for postoperative abdominal infectious complications. World J Surg. 2016;40:3035-43.
5. Matsuo K, Prather CP, Ahn EH, Eno ML, Tierney KE, Yessaian AA, et al. Significance of perioperative infection in survival of patients with ovarian cancer. Int J Gynecol Cancer. 2012;22:245-53.
6. Wołkowicz T, Januszkiewicz A, Szych J. Mikrobiom przewodu pokarmowego i jego dysbiozy jako istotny czynnik wpływający na kondycję zdrowotną organizmu człowieka. Med Dośw Mikrobiol. 2014;66:223-35.
7. Jernberg C, Löfmark S, Edlund C, Jansson JK. Long-term impacts of antibiotic exposure on the human instestinal microbiota. Microbiology. 2010;156:3216-23.
8. Esposito S, Capuano A, Noviello S, Mazzeo F, Ianniello F, Filippelli A. Modification of patients’ endogenous bacterial flora during hospitalization in a large teaching hospital in Naples. J Chemother. 2003;15:568-73.
9. Siegel JD, Rhinehart E, Jackson M, Chiarello L. The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007;3:165-93.www.cdc.gov/infectioncontrol/guidelines/mdro, last update: February, 15, 2017.
10. Valle M, Federici O, Carboni F, Toma L, Gallo MT, Prignano G, et al. Postoperative infections after cytoreductive surgery and HIPEC for peritoneal carcinomatosis: Proposal and results from a prospective protocol study of prevention, surveillance and treatment. EJSO. 2014;40:950-6.
11. Harris AD, Nemoy L, Johnson JA, Martin-Carnahan A, Smith DL, Standiford H, et al. Co-carriage rates of vancomycin-resistant Enterococcus and extended-spectrum beta lactamase-producing bacteria among a cohort of intensive care unit patients: implications for an active surveillance program. Infect Control Hosp Epdemiol. 2004;25:105-8.
12. Ostrowsky BE, Venkataraman L, D’Agata EM, Gold HS, DeGirolami PC, Samore MH. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med. 1999;159:1467-72.
13. Warren DK, Nitin A, Hill C, Fraser VJ, Kollef MH. Occurrence of co-colonization or co-infection with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol. 2004;25: 99-104.
14. Tran CW, McGree ME, Weaver AL, Martin JR, Lemens MA, Cliby WA, et al. Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival. Gynecol Oncol. 2015;136:278-84.
15. Rafii A, Stoeckle E, Jean-Laurent M, Ferron G, Morice P, Houvenaeghel G, et al. Multi-center evaluation of post-operative morbidity and mortality after optimal cytroreductive surgery for advanced ovarian caner. Plose One. http://dx.doi.org/10.1371/journal.pone.0039415, 2012 (accessed 23.07.2012).
16. Sugarbaker PH. Peritonectomy procedures. Ann. Surg. 1995;221:29-42.
17. Sugarbaker PH, Alderman R, Edwards G, Marquardt CE, Gushchin V, Esquivel J, et al. Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy. Ann Surg Oncol. 2006;13:635-44.
18. Capitano B, Nicolau DP. Evolving epidemiology and costs of resistance to antimicrobial agents in long-term care facilities. J Am Med Dir Assoc. 2003;4(3 Suppl):S90-9.
19. Alevizakos M, Gaitanidis A, Nasioudis D, Tori K, Flokas ME, Mylonakis E. Colonization with vancomycin-resistant enterococci and risk for bloodstream infection among patients with malignancy: a systemic review and meta-analysis. Open Forum Infect Dis.2017;4 (1):ofw246, Published online 2016 Dec. 7. https://doi.org/10.1093/ofid/ofw246.
20. Matar MJ, Tarrand J, Raad I, Rolston KV. Colonization and infection with vancomycin-resistant enterococcus among patients with cancer. Am J Infect Control. 2006;34:534-6.
21. Tacconelli E. New strategies to identify patients harbouring antibiotic-resistant bacteria at hospital admission. Clin Microbiol Infect. 2006;12:102-9.
22. Kuehnert MJ, Jernigan JA, Pullen AL, Rimland D, Jarvis WR. Association between mucositis severity and vancomycin-resistant entrococcal bloodstream infection in hospitalized cancer patients. Infect Control Hosp Epidemiol. 1999;20: 660-3.
23. Zaas AK, Song X, Tucker P, Perl TM. Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis. 2002;35:1139-46.
24. Almyroudis NG, Osawa R, Samonis G, Wetzler, Wang ES, McCarthy PL, et al. Discontinuation of systematic surveillance and contact precautions for vancomycin-resistant Enterococcus (VRE) and its impact on the incidence of VRE faecium bacteremia in patients with hematologic malignancies. Infect Control Hosp Epidemiol. 2016;37:398-403.
25. De Angelis G, Cataldo MA, De Waure C, Venturiello S, La Torre G, Cauda R, et al. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systemic review and meta-analysis. J Antimicrob Chemother. 2014;69:1185-92.
26. Farr BM. Hospital wards spreading vancomycin-resistant enterococci to intensive care units: returning coals to Newcastle. Crit Care Med, 1998;26:1942-3.
27. Weinstein JW, Roe M, Towns M, Sanders L, Thorpe JJ, Corey GR, et al. Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital. Infect Control Hosp Epidemiol. 1996;17:36-41.
28. Kang ChI, Wi YM, Lee MY, Ko KS, Chung DR, Peck KR, et al. Epidemiology and risk factors of community onset infections caused by extended-spectrum ß-lactamase-producing Escherichia coli strains. J Clin Microbiol. 2012;50:312-7.
29. Rooney PJ, O’Leary MC, Loughrey AC, McCalmont M, Smyth B, Donaghy P. Nursing homes as a reservoir of extended-spectrum beta-lactamse (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother.2009;64: 635-41.
30. Freeman JT, Gormack S, De Almeida MN, Roberts SA. Natural history of rectal colonization with extended–spectrum betalactamase producing Enterobacteriaceae: a retrospective review with up to 6 years of follow-up. Healthcare Infection. 2013;18:152-5. https://doi.org/10.1071/HI13013.
31. Thouverez M, Talon D, Bertrand X. Control of Enterobacteriaceae producing extended-spectrum beta-lactamase in intensive care units: rectal screening may not be needed in non-epidemic situations. Infect Control Hosp Epidemiol. 2004;25:838-41.
32. Zahar JR, Lortholary O, Martin C, Potel G, Plesiat P, Nordmann P. Addresssing the challenge of extended-spectrum beta-lactamases. Curr Opin Invest Drugs. 2009;10:172-80.
33. Demiraslan H, Cevahir F, Berk E, Metan G, Cetin M, Alp E. Is surveillance for colonization of carbapenem-resistant gram-negative bacteria important in adult bone marrow transplantation units? Am J Infect Control. 2017;45:735-9.
34. Zimmerman FS., Assous MV, Bdolah-Abram T, Lachish T, Yinnon AM, Wiener-Well Y. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control. 2013;41:190-4.
35. Zalecenia dotyczące postępowania w przypadku identyfikacji w zakładach opieki zdrowotnej szczepów bakterii Enterobacteriaceae wytwarzających karbapenemazy typu KPC. http://www.antybiotyki.edu.pl/pdf/KPC-20100305.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.
Copyright (c) 2018 Authors