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.

Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria / 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, A.; Gramegna, D.; Russo, D.; Lazzarotto, D.; Rotilio, D.; De Paolis, M. R.; Simonetti, E.; Innocente, M. A.; Spadea, A.; Mazziotta, F.; Pegoraro, A.; Spolzino, A.; Turri, G.; Veggia, B.. - In: ANNALS OF HEMATOLOGY. - ISSN 0939-5555. - 97:9(2018), pp. 1717-1726. [10.1007/s00277-018-3341-6]

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

Candoni A.;
2018-01-01

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.
97
9
1717
1726
Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria / 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, A.; Gramegna, D.; Russo, D.; Lazzarotto, D.; Rotilio, D.; De Paolis, M. R.; Simonetti, E.; Innocente, M. A.; Spadea, A.; Mazziotta, F.; Pegoraro, A.; Spolzino, A.; Turri, G.; Veggia, B.. - In: ANNALS OF HEMATOLOGY. - ISSN 0939-5555. - 97:9(2018), pp. 1717-1726. [10.1007/s00277-018-3341-6]
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, A.; Gramegna, D.; Russo, D.; Lazzarotto, D.; Rotilio, D.; De Paolis, M. R.; Simonetti, E.; Innocente, M. A.; Spadea, A.; Mazziotta, F.; Pegoraro, A.; Spolzino, A.; Turri, G.; Veggia, B.
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