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28.04.2018 | Original Article | Ausgabe 9/2018

Annals of Hematology 9/2018

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

Zeitschrift:
Annals of Hematology > Ausgabe 9/2018
Autoren:
C. Cattaneo, R. Di Blasi, C. Skert, A. Candoni, B. Martino, N. Di Renzo, M. Delia, S. Ballanti, F. Marchesi, V. Mancini, E. Orciuolo, S. Cesaro, L. Prezioso, R. Fanci, G. Nadali, A. Chierichini, L. Facchini, M. Picardi, M. Malagola, V. Orlando, E. M. Trecarichi, M. Tumbarello, F. Aversa, G. Rossi, L. Pagano, on behalf of SEIFEM Group

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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