Gut Colonization with Carbapenem-resistant Enterobacteriaceae Adversely Impacts the Outcome in Patients with Hematological Malignancies: Results of A Prospective Surveillance Study.

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 of 225 consecutive patients of HM over 28 months. RESULTS: The median age of the cohort was 46 years, the majority with acute leukaemia. 48 (21%) patients were colonised with CRE on admission (CAD). Another 46 patients were colonised with CRE in the hospital (CIH). The risk factors for CAD and CIH were a diagnosis of acute leukaemia and duration of hospital stay respectively. CRE accounted for 77% of infection-related mortality (IRM). The incidence of CRE bacteremia in CRE positive patients was 18% (17/94), and mortality in those with CRE bacteremia was 100%. IRM was 35.3% in CIH group compared to 10.5% in the CAD group (p=0.0001). IRM was highest in those with acute myeloid leukaemia (AML) and CIH (54.9% p=0.0001). On multivariate analysis, CIH was the most important risk factor for IRM (HR-7.2). CONCLUSION: Our data demonstrate that a substantial proportion of patients with HM are colonised with CRE without prior hospitalisation, but those with nosocomial colonisation have the highest risk of mortality, particularly in those with AML.

Prostatic Adenocarcinoma Incognito Manifestation as Generalized Lymphadenopathy: a Rare Case Report.

Generalized lymphadenopathy is a rare manifestation of carcinoma prostate. Here, we report a case of a 73-year-old male who presented with left supraclavicular lymphadenopathy along with hoarseness of voice and weight loss. His CT neck, chest, abdomen, and subsequently18F-FDG PET CT were suggestive of generalized lymphadenopathy with skeletal involvement. He was not having any urinary or bone symptoms. The biopsy of supraclavicular lymph node revealed metastatic adenocarcinoma, whose prostatic origin was suggested by IHC staining of PSA. The diagnosis was confirmed by prostatic biopsy along with markedly raised serum PSA. We emphasize that in men with adenocarcinoma of undetermined origin, a suspicion of prostate cancer is important for accurate diagnosis and therapeutic approach.