Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients

Carena, Alberto; Laborde, Ana; Roccia-Rossi, Inés; Palacios, Cynthia Jimena; Jordán, Rosana; Valledor, Alejandra; Nenna, A; Costantini, Patricia; Dictar, Miguel; Herrera, Fabián

doi:10.1016/j.bjid.2019.11.001

Cited by 4 publications

(3 citation statements)

References 38 publications

(99 reference statements)

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“…Studies demonstrated that AML and allogeneic HSCT, prior antibiotic exposure and ICU admission, prolonged duration of hospitalization and neutro-penia were risk factors for ESBLs-producing Enterobacterales bacteremia (11,(17)(18)(19)(20)(21). Having a prior culture that grew MDR microorganisms and receiving glucocorticosteroids were independent risk factors for MDR microorganisms related bacteremia in several studies (11,(22)(23)(24)(25). Our results were in accordance with the results of these studies regarding the factors associated with GNB.…”

Section: Discussionsupporting

confidence: 90%

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Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Ayaz¹,

Hazırolan²,

Sancak³

et al. 2022

Infect Dis Clin Microbiol

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Objective: Patients with hematological malignancies (HMs) have a substantial incidence of febrile neutropenic episodes. Gram-negative bacteremia (GNB) is still the major cause of these episodes. We evaluated the factors associated with GNB and mortality of bacteremic patients with HMs in a high-resistance setting. Materials and Methods:We conducted a prospective cohort study from March 2018 to June 2019 with 66 bacteremic and 132 non-bacteremic patients. Regression analyses were used to identify factors associated with GNB and 30-day mortality. Results:The mean age was 53.83±15.21 years, and 129 (65.2%) of the patients were male. In multivariable analysis, factors independently associated with GNB were male gender, duration of hospitalization and neutropenia before the febrile neutropenic episode, leukemias and allogeneic transplant recipients, radiotherapy, receiving glucocorticosteroids, colonization with resistant microorganisms. All-cause mortality and 30-day mortality were 47.0% and 30.3% in cases of GNB, compared to non-bacteremic controls 25.0% and 10.6%, respectively. Sepsis, duration of hospitalization before the febrile neutropenic episode, carbapenem-resistant GNB, and inappropriate empirical antibiotic treatment was found as factors associated with 30-day mortality. Prior antibiotic exposure particularly beta-lactamase inhibitor combinations and carbapenems during the past 30 days was more frequent in the bacteremic group. An increasing trend was observed in multidrug-resistant (MDR) bacteria (p=0.03) and carbapenem-resistant Enterobacterales (p=0.02) over the years. Conclusion:By considering the risk factors associated with GNB and 30-day mortality that we detected in our study among neutropenic patients, a personalized approach for the management of febrile neutropenic patients can be designed by means of an effective antimicrobial stewardship program including the appropriate use of broad-spectrum antibiotics.

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Section: Discussionsupporting

confidence: 90%

“…Male gender was a factor associated with acquiring GNB in our study. The literature included mixed results in this respect (17,21,23,26). In our study, all-cause mortality was 47.0% in cases of GNB, compared to non-bacteremic controls at 25.0%.…”

Section: Discussionmentioning

confidence: 47%

Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Ayaz¹,

Hazırolan²,

Sancak³

et al. 2022

Infect Dis Clin Microbiol

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“…Hematologic malignancy, neutropenia, contact with the health care environment, hospitalization, use of devices, admission to an intensive care unit (ICU) in the past three months, recent colonization by an MDR microorganism, and changes in the microbiota due to use of antimicrobials are considered risk factors associated with the transmission of MDR microorganisms [60,61]. Multicentre studies have reported high rates of bacteremia in cancer patients caused by MDR bacteria, especially the ESBLproducers and the carbapenem-resistant ones [61][62][63][64][65].…”

Section: Antibiotic Resistance and Infection Preventionmentioning

confidence: 99%

Healthcare-associated infections in patients who are immunosuppressed due to chemotherapy treatment: a narrative review

Silva

Casella²

2022

J Infect Dev Ctries

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Introduction: Chemotherapy is one of the best methods to cure oncologic patients. However, it leads to adverse effects that contribute to the establishment of infections. Up-to-date knowledge is needed to offer the best care to patients. Methodology: This is a narrative review based on searching articles in five databases (PubMed, LILACS, Research Gate, Google Scholar, and SciELO) using “cancer treatments”, “chemotherapy”, “febrile neutropenia”, “cancer opportunistic infections”, “chemotherapy AND febrile neutropenia”, “cancer AND hospital infections”, and “immunosuppression AND cancer patients” as keywords. No filter was applied, however, articles published in the last five years were preferentially selected to compose this article. Results: Almost all microorganisms can cause infection in cancer patients, including colonizing and normal microbiota. However, Escherichia coli, Pseudomonas aeruginosa, Klebsiella spp., Staphylococcus spp., and Streptococcus spp. are the most reported agents. Viruses may be underrepresented because molecular techniques are needed to identify them. Bloodstream and associated infections are among the highest occurrences because of the devices that are constantly introduced. Antibiotic administration selects for resistant microorganisms, which leads to delay or even failure in the treatment. Protocols for efficient infection prevention and control measures must involve staff from the kitchen, janitors, nurses, and physicians, in addition to patients and relatives. Conclusions: Bloodstream infections caused by the bacteria and which have the most resistance to several antimicrobials are the main concern for oncologic patients. Preventive and educative actions must be taken by a multidisciplinary team in order to achieve the best care for the vulnerable patients.

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The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis

et al. 2023

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Background Bloodstream infections (BSIs) produced by antibiotic-resistant bacteria (ARB) cause a substantial disease burden worldwide. However, most estimates come from high-income settings and thus are not globally representative. This study quantifies the excess mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and economic costs associated with ARB BSIs, compared to antibiotic-sensitive bacteria (ASB), among adult inpatients in low- and middle-income countries (LMICs). Methods and findings We conducted a systematic review by searching 4 medical databases (PubMed, SCIELO, Scopus, and WHO’s Global Index Medicus; initial search n = 13,012 from their inception to August 1, 2022). We only included quantitative studies. Our final sample consisted of n = 109 articles, excluding studies from high-income countries, without our outcomes of interest, or without a clear source of bloodstream infection. Crude mortality, ICU admission, and LOS were meta-analysed using the inverse variance heterogeneity model for the general and subgroup analyses including bacterial Gram type, family, and resistance type. For economic costs, direct medical costs per bed-day were sourced from WHO-CHOICE. Mortality costs were estimated based on productivity loss from years of potential life lost due to premature mortality. All costs were in 2020 USD. We assessed studies’ quality and risk of publication bias using the MASTER framework. Multivariable meta-regressions were employed for the mortality and ICU admission outcomes only. Most included studies showed a significant increase in crude mortality (odds ratio (OR) 1.58, 95% CI [1.35 to 1.80], p < 0.001), total LOS (standardised mean difference “SMD” 0.49, 95% CI [0.20 to 0.78], p < 0.001), and ICU admission (OR 1.96, 95% CI [1.56 to 2.47], p < 0.001) for ARB versus ASB BSIs. Studies analysing Enterobacteriaceae, Acinetobacter baumanii, and Staphylococcus aureus in upper-middle-income countries from the African and Western Pacific regions showed the highest excess mortality, LOS, and ICU admission for ARB versus ASB BSIs per patient. Multivariable meta-regressions indicated that patients with resistant Acinetobacter baumanii BSIs had higher mortality odds when comparing ARB versus ASB BSI patients (OR 1.67, 95% CI [1.18 to 2.36], p 0.004). Excess direct medical costs were estimated at $12,442 (95% CI [$6,693 to $18,191]) for ARB versus ASB BSI per patient, with an average cost of $41,103 (95% CI [$30,931 to $51,274]) due to premature mortality. Limitations included the poor quality of some of the reviewed studies regarding the high risk of selective sampling or failure to adequately account for relevant confounders. Conclusions We provide an overview of the impact ARB BSIs in limited resource settings derived from the existing literature. Drug resistance was associated with a substantial disease and economic burden in LMICs. Although, our results show wide heterogeneity between WHO regions, income groups, and pathogen–drug combinations. Overall, there is a paucity of BSI data from LMICs, which hinders implementation of country-specific policies and tracking of health progress.

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Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients

Cited by 4 publications

References 38 publications

Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Healthcare-associated infections in patients who are immunosuppressed due to chemotherapy treatment: a narrative review

The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis

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