Prognostic factors and scoring model of hematological malignancies patients with bloodstream infections

et al. 2020

Preprint

Self Cite

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) associated infections are a major threat to patient safety. Methods: A single-center, retrospective case-control study representing 734 patients with hematologic malignancies between January 1, 2017 and December 31, 2018 was conducted. Demographic and clinical data were collected from the hospital electronic medical records system. Results: Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt Bacteremia Score (PBS) >4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors . Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR,11.067; CI=4.43-27.644; P<0.001; 3 points), severe neutropenia (OR,4.095; CI=0.876-19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR,18.444; CI=1.787-190.343; P=0.014; 4 points). The total risk score of ≥5 indicated that the probability of CRKP BSI occurrence was above 48%. Conclusions: CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor–based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes. Keywords: Carbapenem-resistant Klebsiella pneumoniae ; bloodstream infection; hematologic malignancy; risk factors; prediction

Section: Discussionsupporting

confidence: 92%

Clinical Characteristics and Risk Factors for Bloodstream Infection due to Carbapenem-Resistant Klebsiella Pneumoniae in Patients with Hematologic Malignancies

Zhang

et al. 2020

Preprint

Self Cite

“…The overall 30-day mortality rate was 24.7%, however, the mortality of the CRKP group reached 55.0%, in line with previous works [3,4]. Not surprisingly, the appropriate empirical antibiotic therapy was discovered as a protective factor for BSI patients, a factor that has been proven by some previous studies on BSIs caused by Enterobacteriaceae in both common populations and hematological patients [4,15,18]. Interestingly, although the mortality in the CRKP group was higher than that in the CSKP group (55.0% vs 15.9%, P = 0.001), CRKP infection was not a risk factor for mortality.…”

Section: Discussionsupporting

confidence: 84%

Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients

Liu

Huang

et al. 2019

J Infect Dev Ctries

Introduction: Carbapenem-resistant Klebsiella pneumoniae (KP) serves as a major threat to onco-hematological patients, resulting in great morbidity and mortality. The purpose of our study was to identify the risk factors for KP bloodstream infections (BSIs) and mortality in onco-hematological patients. Methodology: A retrospective observation study was conducted on KP BSIs in the onco-hematology departments at Xiangya hospital from January 2014 to September 2018. Multivariate analysis was employed to identify the independent risk factors for carbapenem-resistant (CR) KP BSIs and related mortality. Results: A total of 89 strains of KP were analyzed in our study, in which 20 strains were CRKP. The only risk factor for CRKP BSI was carbapenem exposure within 30 days before the onset of BSIs (HR 25.122). The 30-day mortality was 24.7%. CRKP caused more mortality than carbapenem-susceptible KP (55.0% vs 15.9%, P = 0.001). In the multivariate analysis, unresolved neutropenia (HR 16.900), diarrhea (HR 3.647) and RDW > 14% (HR 6.292) were independent risk factors for mortality, and appropriate empirical therapy (HR 0.164) was protective against mortality. Conclusions: Our findings showed that carbapenem resistance was spreading in our setting, and a precise combination of antibiotics covering the common pathogen is crucial to improving patient survival.

“…Comparison of characteristics between the survival and non-survival groups. The appropriateness of empirical antibiotic therapy is closely linked to mortality among hematological patients, which has been proven by previous works [14,15]. However, the clinicians' choice of antibiotics is still unclear.…”

Section: Discussionmentioning

confidence: 94%

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Liu

Huang

et al. 2019

J Infect Dev Ctries

Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders. Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated. Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group. Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.