A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Abstract

Background: Bloodstream infection (BSI) is a common and serious complication after patients with hematologic malignancies (HM) receiving chemotherapy. This study examined real-world data seeking to characterize HM BSI and identify risk factors for BSI emergence and mortality. Methods: We retrospectively analyzed the pathogenic epidemiology, antibiotic resistance, and BSI risk factors in a single-center cohort including 3014 consecutive patients with HM receiving chemotherapy between 2013 and 2016. Results of the pathogenic epidemiology were validated via comparison to available reported data. Results: We found that 725 patients (24.1%) had BSIs. Gram-negative (G-) bacteria represented 64.7% of the 744 isolated pathogenic strains, while Gram-positive (G+) bacteria and fungi accounted for 27.7% and 7.7% of the BSIs, respectively. The most common isolates were Klebsiella pneumoniae (19.2%), and 95.1% of the multidrug-resistant strains (MDR) were extended-spectrum beta-lactamase producing strains. G- bacteria were the main microflora responsible for BSI in our cohort of Chinese HM patients compared to studies in developed countries or in neutropenic children with HM or solid tumors. Multivariate analysis revealed that male sex, age ≥ 45 and < 65 yr, hospital length of stay ≥ 9d, neutropenia ≥ 7d before cultures, ≥ 2 antibiotics, and infections (gastrointestinal, perirectal, or urinary tract) independently predicted BSI emergence. Furthermore, age ≥ 65 yr, neutropenia ≥ 7d before blood cultures, no HM remission, lower white blood cell count, ≥ 3 antibiotics, respiratory infections, and Acinetobacter baumannii and Stenotrophomonas maltophilia BSI were independent predictors of 30-day mortality. Conclusions: G- bacteria were the predominant microflora during the study period and antibiotic resistance levels of the pathogens detected were high, especially for MDR strains. The mortality of BSI patients was high in this large cohort. Close attention should be paid to the risk factors identified here to facilitate timely and effective clinical management of such patients.

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China

“…This kind of patients were predisposed to developing BSI probably because of bone marrow suppression, neutropenia and mucosal injury induced by chemotherapy. 21 Therefore, this result confirmed the substantial burden of these pathogens in younger patient in our region, justifying the implementation of programs to prevent GNBSI in this age group. [25][26][27] On the other hand, the orthopedics in our hospital is a national key discipline.…”

“…This was similar to previous research. 21 The isolation rate of negative bacteria increased year by year; however, the isolation rate of positive bacteria did not change much from year to year. This may be related to prolonged hospitalization, low overall immunity, and the use of broad-spectrum antibiotics in hospital which resulting in the increased likelihood of nosocomial bacterial infection.…”

Pseudomonas aeruginosa Infections in Cancer Patients

“…In cancer patients, especially in those with hematologic malignances, this percentage is higher (11-18% all BSI cases). In this group of patients, P. aeruginosa is second or third after E. coli and K. pneumoniae as a causative agent of BSI [39][40][41][42].…”

Clinical outcomes of antimicrobial resistance in cancer patients: A systematic review of multivariable models

“…In total, there were 23/144 (16%) studies of patients with solid cancers , 65/144 (45%) studies of patients with haematological cancers (41-105), and 56/144 (39%) studies with patients of both or unspecified cancer types (106-161). Most studies selected (39/144, 27%) reported and modelled several bacteria and/or fungi that were tested for resistances towards several antimicrobials (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(106)(107)(108)(109)(110)(111)(112)(113)(114)(115). Eight of 144 (6%) reporting and modelling several microorganisms focused only on Gram-negative bacteria (54)(55)(56)(57)(58)(116)(117)(118)) and 1/144 (1%) focused only on fungi (59).…”