Bloodstream infections in adult patients with malignancy, epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance

Abstract

Background This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. Methods We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. Results 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015–2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. Conclusions The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options.

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

“…Each patient with positive blood culture and identified from one or more blood specimens obtained by culture and at least one sign or symptom which included fever (>38°C), chills, or hypotension and not be related to an infection at another site were considered as true BSI. 28 This was estimated by professional physicians. Multidrug-resistant (MDR) bacteria were defined according to the European Centre for Disease Prevention and Control (ECDC) criteria ( https://www.ecdc.europa.eu/en ).…”

“…This result was consistent with previous studies performed in China, Iran, Sweden and Rwanda. [28][29][30][31][32] While an Italian study showed that the most frequently isolated pathogens were K. pneumoniae (45.3%), followed by E. coli (15.4%). 33 This difference in primary bacteria might be associated with geographic area.…”

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

“…MDR- K. pneumoniae has a strong drug-resistant ability through several mechanisms including target alteration, drug inactivation, decreased cell permeability, and increased efflux pump activity [ 10 – 13 ]. MDR- Klebsiella pneumoniae is found as a dangerous pathogen for hospital-acquired infections because of the limited antibiotic regimens [ 14 – 16 ]. Similarly, some studies have given an account of MDR bacterial infections among AP patients which aimed to differentiate between MDR and non-MDR bacterial infections, but devoted to the aspect of the drug-resistance and predictors for mortality of AP patients complicated with MDR infections [ 5 , 15 , 17 ].…”

Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Tertiary Hospital in Northern China

“…In recent years, with the abuse and overuse of antibiotics, particularly the third-generation cephalosporins and carbapenems, carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged rapidly in China, with the carbapenem resistant rate increasing from 3% in 2005 to 25.5% in 2021 based on the data of CHINET [ 3 , 4 ]. The majority of CRKP isolates was resistant to more than three kinds of antibiotics and was defined as multidrug resistance (MDR) [ 5 ]. Therefore, infections caused by CRKP pose serious threats to global public health security and an enormous challenge to antimicrobial therapy.…”