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

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.

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Acknowledgments

On behalf of SEIFEM Group, Angela Passi, Doriana Gramegna (Haematology, Spedali Civili, Brescia, Italy); Domenico Russo (Chair of Haematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, Italy); Davide Lazzarotto (Division of Haematology and Stem Cell Transplantation, University Hospital of Udine, Udine, Italy); Domenico Rotilio (Haematology Unit, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy); Maria Rosaria De Paolis, UOC di Ematologia e Trapianto di Cellule Staminali“, PO “Vito Fazzi” Lecce); Edoardo Simonetti, Maria Alessandra Innocente (Institute of Haematology and Stem Cell transplantation, Ospedale Santa Maria della Misericordia, University of Perugia, Italy); Antonio Spadea (Haematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Rome, Italy); Francesco Mazziotta (Haematology Unit, Azienda Ospedaliero-Universitaria Pisana, Ospedale Santa Chiara, Pisa, Italy); Anna Pegoraro (Pediatric Haematology Oncology), Giuliana Lo Cascio (Microbiology and Virology) (Azienda Ospedaliera Universitaria integrata, Verona, Italy); Angelica Spolzino (Haematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy); Gloria Turri (Section of Haematology, Department of Clinical and Experimental Medicine, University of Verona, Italy); Barbara Veggia (UOC Ematologia Azienda Ospedaliera S. Giovanni Addolorata, Rome, Italy).

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Correspondence to C. Cattaneo.

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The study was approved by the ethics committee of each of the participating institutions, and informed consent was obtained from all patients for being included in the study. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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The authors declare that they have no conflict of interest.

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Cattaneo, C., Di Blasi, R., Skert, C. et al. Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria. Ann Hematol 97, 1717–1726 (2018). https://doi.org/10.1007/s00277-018-3341-6

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Keywords

  • Haematologic patients
  • Multidrug-resistant bacteria
  • Colonization
  • Bloodstream infections