1. Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria
- Author
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Lucia Prezioso, Michele Malagola, Maria Alessandra Innocente, Edoardo Simonetti, Livio Pagano, Angelica Spolzino, R Di Blasi, Barbara Veggia, Angela Passi, Luca Facchini, Simone Cesaro, Gianpaolo Nadali, Doriana Gramegna, Marco Picardi, Gloria Turri, Antonio Spadea, Enrico Orciuolo, Stelvio Ballanti, Anna Candoni, Cristina Skert, Davide Lazzarotto, Enrico Maria Trecarichi, Francesco Marchesi, Vincenza Orlando, Rosa Fanci, Mario Delia, Maria Rosaria De Paolis, Domenico Russo, Bruno Martino, Valentina Mancini, N. Di Renzo, Anna Chierichini, Giorgio Rossi, Anna Pegoraro, Mario Tumbarello, Cristina Cattaneo, Francesco Mazziotta, Domenico Rotilio, Franco Aversa, Cattaneo, C., Di Blasi, R., Skert, C., Candoni, A., Martino, B., Di Renzo, N., Delia, M., Ballanti, S., Marchesi, F., Mancini, V., Orciuolo, E., Cesaro, S., Prezioso, L., Fanci, R., Nadali, G., Chierichini, A., Facchini, L., Picardi, M., Malagola, M., Orlando, V., Trecarichi, E. M., Tumbarello, M., Aversa, F., Rossi, G., Pagano, L., Passi, Angela, Gramegna, Doriana, Russo, Domenico, Lazzarotto, Davide, Rotilio, Domenico, De Paolis, Maria Rosaria, Simonetti, Edoardo, Innocente, Maria Alessandra, Spadea, Antonio, Mazziotta, Francesco, Pegoraro, Anna, Spolzino, Angelica, Turri, Gloria, and Veggia, Barbara
- Subjects
0301 basic medicine ,Male ,Colonization ,Multidrug-resistant bacteria ,Antibiotics ,Drug Resistance ,Bacteremia ,Bloodstream infections ,Haematologic patients ,Adolescent ,Adult ,Aged ,Aged, 80 and over ,Bacterial Infections ,Catheter-Related Infections ,Child ,Child, Preschool ,Female ,Hematologic Neoplasms ,Humans ,Infant ,Infant, Newborn ,Middle Aged ,Young Adult ,Drug Resistance, Multiple, Bacterial ,0302 clinical medicine ,80 and over ,030212 general & internal medicine ,Young adult ,Pathogen ,Hematology ,Incidence (epidemiology) ,Bacterial ,General Medicine ,Bloodstream infections, haematological cancer patients, multidrug-resistant bacteria ,Haematologic patient ,Multiple ,Human ,medicine.medical_specialty ,medicine.drug_class ,030106 microbiology ,Neutropenia ,Bloodstream infection ,Bacterial Infection ,03 medical and health sciences ,Internal medicine ,medicine ,Preschool ,Hematologic Neoplasm ,Catheter-Related Infection ,business.industry ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,Newborn ,bacterial infections and mycoses ,business - Abstract
Infections by multidrug-resistant (MDR) bacteria are a worrisome phenomenon in hematological patients. Data on the incidence of MDR colonization and related bloodstream infections (BSIs) in haematological patients are scarce. A multicentric prospective observational study was planned in 18 haematological institutions during a 6-month period. All patients showing MDR rectal colonization as well as occurrence of BSI at admission were recorded. One-hundred forty-four patients with MDR colonization were observed (6.5% of 2226 admissions). Extended spectrum beta-lactamase (ESBL)-producing (ESBL-P) enterobacteria were observed in 64/144 patients, carbapenem-resistant (CR) Gram-negative bacteria in 85/144 and vancomycin-resistant enterococci (VREs) in 9/144. Overall, 37 MDR-colonized patients (25.7%) developed at least one BSI; 23 of them (62.2%, 16% of the whole series) developed BSI by the same pathogen (MDRrel BSI), with a rate of 15.6% (10/64) for ESBL-P enterobacteria, 14.1% (12/85) for CR Gram-negative bacteria and 11.1% (1/9) for VRE. In 20/23 cases, MDRrel BSI occurred during neutropenia. After a median follow-up of 80 days, 18 patients died (12.5%). The 3-month overall survival was significantly lower for patients colonized with CR Gram-negative bacteria (83.6%) and VRE (77.8%) in comparison with those colonized with ESBL-P enterobacteria (96.8%). CR-rel BSI and the presence of a urinary catheter were independent predictors of mortality. MDR rectal colonization occurs in 6.5% of haematological inpatients and predicts a 16% probability of MDRrel BSI, particularly during neutropenia, as well as a higher probability of unfavourable outcomes in CR-rel BSIs. Tailored empiric antibiotic treatment should be decided on the basis of colonization.
- Published
- 2018