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

Autor: Samane Nematolahi, Shabnam Ghasempour, Ali Amanati, Salma Mehrangiz, Somayeh Khajeh, Sarvin Sajedianfard, Zahra Shahhosein
Rok vydání: 2021
Předmět:
Male
0301 basic medicine
Carbapenem-resistant isolates
medicine.medical_specialty
030106 microbiology
Bacteremia
Infectious and parasitic diseases
RC109-216
Drug resistance
Bloodstream infection
Iran
Microbiology
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Medical microbiology
Risk Factors
Neoplasms
Sepsis
Drug Resistance
Bacterial
Epidemiology
medicine
Humans
030212 general & internal medicine
Mortality
Cancer
Retrospective Studies
Bacteria
biology
business.industry
Incidence (epidemiology)
Mortality rate
Enterobacter
Middle Aged
Acinetobacter
biology.organism_classification
Combined Modality Therapy
Drug Resistance
Multiple
Klebsiella pneumoniae
Infectious Diseases
Multidrug-resistant gram-negative infection
Female
Extended-Spectrum Beta-lactamase producing pathogens
business
Research Article
Zdroj: BMC Infectious Diseases
BMC Infectious Diseases, Vol 21, Iss 1, Pp 1-14 (2021)
ISSN: 1471-2334
DOI: 10.1186/s12879-021-06243-z
Popis: 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.
Databáze: OpenAIRE
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