Characteristics, Outcomes, and Clinical Indicators of Bloodstream Infections in Neutropenic Patients with Hematological Malignancies: A 7-Year Retrospective Study

Abstract

The aim of this study was to investigate the current epidemiology, its changes during the study years, and inflammatory biomarkers of bacterial bloodstream infections (BSIs) in neutropenic patients with hematological malignancies. We assessed mortality risk factors and multidrug-resistant (MDR) gram-negative BSI predictors. Patients and Methods:We conducted a retrospective study from January 2015 to December 2021, which included adult neutropenic oncohematological patients with confirmed BSIs. We used univariable and multivariable analyses to analyze the risk factors. Each index's reliability for bacterial BSI diagnosis was assessed using the receiver-operating characteristic curve and area under the curve. Results: A total of 514 isolates were obtained from the 452 patients. The average mortality was 17.71%. Gram-negative organisms were the predominant causes of BSI. Escherichia coli was the most common microorganism (49.90%). The overall variation trend of the isolation rate of MDR and carbapenem-resistant gram-negative bacteria increased. Multivariate analysis indicated that: 1) neutropenia that lasted for more than 7 days, patients ≥ 60 years of age, septic shock, hospitalization for >20 days, BSI with a carbapenem-resistant strain, and treatment with linezolid or vancomycin in infections lasting less than 30 days were independent mortality risk factors; 2) severe neutropenia exceeding 7 days, unreasonable empirical therapy, and receipt of aminoglycosides or 3rd or 4th generation cephalosporins in infections lasting less than 30 days were independent risk factors of MDR gram-negative bacteria. Procalcitonin, absolute neutrophil count, and white blood cell indicate higher diagnostic accuracy for BSIs. Moreover, bacteria time to detection was better at differentiating Gram-negative and Gram-positive bacterial infections. Conclusion:We analyzed the risk factors for BSI neutropenic patients with hematological malignancies, the distribution of bacteria, antibiotic resistance, and the changes in clinical parameters. This single-center retrospective study may provide clinicians with novel insights into the diagnosis and treatment of BSI to improve future clinical outcomes.

Epidemiology and Prognosis of Sepsis in Cancer Patients: A Multicenter Prospective Observational Study

“…Mortality from bloodstream infections in cancer patients was reported to be 1.59 times higher with bacteremia caused by an MDR bacterium in one study [22]. Carbapenem-resistant strains were reported to be a risk factor for mortality in a retrospective 7-year study on the prognosis of bloodstream infections in neutropenic patients with hematologic malignancies [23]. Inappropriate administration of empirical treatment was also found to be a risk factor for mortality in this study [23].…”

“…Carbapenem-resistant strains were reported to be a risk factor for mortality in a retrospective 7-year study on the prognosis of bloodstream infections in neutropenic patients with hematologic malignancies [23]. Inappropriate administration of empirical treatment was also found to be a risk factor for mortality in this study [23]. The early initiation of appropriate empiric therapy in the treatment of sepsis is an important factor in mortality [4].…”