Bloodstream infections with gram-negative organisms and the impact of multidrug resistance in patients with hematological malignancies

Abstract

Infections and especially blood stream infections (BSI) with gram-negative bacteria (GNB) represent a major threat for patients with hematological diseases undergoing chemotherapy and mainly contribute to morbidity and mortality. In this retrospective single-center study, we analyzed the impact of BSI with different gram-negative multidrug-resistant bacteria (MDRGN) compared to BSI with antibiotic susceptible gram-negative bacteria. Data of 109 patients with hematological malignancies and GNB BSI were analyzed with overall survival (OS) 30 days after BSI being the primary endpoint. BSI with non-fermentative gram-negative bacteria were found in 26.6% of all patients and 73.4% suffered from a BSI with an Enterobacteriaceae. Thirty-two of 109 patients suffered from BSI with MDRGN. Characteristics of MDRGN and non-MDRGN BSI patients did not differ besides the fact that significantly more patients received an immunosuppressive therapy in the MDRGN BSI group. OS (30 days after BSI) of patients with MDRGN BSI was significantly lower (85.6 vs. 55.9%; p < 0.001) compared to patients with non-MDRGN BSI. Patients with MDRGN BSI with non-fermentative pathogens had a worse OS after 30 days compared to MDRGN BSI with Enterobacteriaceae and the same holds true for non-MDRGN BSI. In multivariate analysis of MDRGN BSI, non-fermenters and ICU admission were independently associated with increased 30-day mortality. Our data demonstrate the negative impact of non-fermentative gram-negative pathogens causing BSI compared to Enterobacteriaceae in hematological patients and thereby underlining the heterogeneity of gram-negative BSI.

Multi-drug resistance bacteria predict mortality in blood stream infection in a tertiary setting in Tanzania

“…266 Infection due to multi-drug resistance bacteria was an independent predictor of mortality in our 267 study. This finding was comparable to previous studies in Africa and elsewhere (2,18).…”

The Management of Hematologic Patients with Bloodstream Infections Due to Multi-Drug Resistant Bacteria: Where Do We Stand? From Antibacterial Prophylaxis to the Treatment of Septic Shock

“…Important risk factors for developing MDR infections are exposure to broad-spectrum antibiotic therapy, especially within the last month before the infectious episode, in-hospital/ICU staying, prior colonization, indwelling devices [32,33], all frequently found in HSCT recipients and hematological patients. BSI from MDR Gram-negative bacteria is associated with significantly lower overall survival (OS) compared to hematological patients with non-MDR Gram-negative BSI [15,34,35].…”

Ceftazidime/Avibactam and Ceftolozane/Tazobactam for Multidrug-Resistant Gram Negatives in Patients with Hematological Malignancies: Current Experiences

“…Among hematologic patients, those affected by acute leukemias and lymphoproliferative diseases are particularly vulnerable. Considering the impairment of the immune system due to underlying malignancies and frequent neutropenia following chemotherapy, they are at high risk for severe infections, including in particular bloodstream infections (BSIs), which represent one of the most frequent life-threatening complications for these patients, with reported mortality rates reaching 40% [1][2][3][4]. While Gram-positive bacteria represented the most frequent etiological agents of bacterial BSIs in patients with hematological malignancies until the last century, during the last decades a clear epidemiological shift has been reported, with Gram-negatives becoming the most prevalent cause [5,6].…”

“…While Gram-positive bacteria represented the most frequent etiological agents of bacterial BSIs in patients with hematological malignancies until the last century, during the last decades a clear epidemiological shift has been reported, with Gram-negatives becoming the most prevalent cause [5,6]. Moreover, a worrisome increase in antimicrobial resistance of Gram-negative bacteria (e.g., cephalosporin-and/or carbapenem-resistant Enterobacteriaceae and multidrug-resistant (MDR) Pseudomonas aeruginosa) involved in severe infectious complications among patients with hematological malignancies has been recently reported [3][4][5][6]. Due to scheduled recurrent and often prolonged hospital admissions, colonization and possible subsequent infections by MDR bacteria have been increasingly reported in the specific setting of hematological patients, particularly in countries with high MDR bacteria prevalence [1,3,[6][7][8][9].…”

“…In general, several studies have reported significantly higher mortality rates among patients suffering from hematological malignancies and BSIs due to MDR Gram-negative bacteria compared to those with BSIs due to susceptible strains, and often, antimicrobial resistance by bacterial isolates and/or the related inadequacy of empirical antimicrobial treatments have been demonstrated among the most important independent risk factors for mortality [1][2][3][4][5][6][12][13][14].…”