Journal Article

Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria

Mazziotta, Francesco, Veggia, Barbara, Fanci, R, Prezioso, L, Simonetti, Edoardo, Aversa, F, Orlando, V, Turri, Gloria, Pegoraro, Anna, Marchesi, F, Chierichini, A, Tumbarello, M, Innocente, Maria Alessandra, Skert, C, Martino, B, Ballanti, S, Delia, M, Facchini, L, Mancini, V, Passi, Angela, Cesaro, S, Russo, Domenico, R Di Blasi, De Paolis, Maria Rosaria, Nadali, G, Candoni, A, Orciuolo, E, Malagola, M, Gramegna, Doriana, Spolzino, Angelica, Trecarichi, E M, Rossi, G, Pagano, L, Spadea, Antonio, Rotilio, Domenico, Picardi, M, Cattaneo, C, Lazzarotto, Davide, N Di Renzo

2018

Overview

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.

• Publisher: Springer Nature B.V
• Subject: Bacteria / Blood cancer / Drug resistance / Gram-negative bacteria / Hematology / Infections / Multidrug resistant organisms / Neutropenia