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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.

journal_name

Ann Hematol

journal_title

Annals of hematology

authors

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,Trecaric

doi

10.1007/s00277-018-3341-6

subject

Has Abstract

pub_date

2018-09-01 00:00:00

pages

1717-1726

issue

eissn

0939-5555

issn

1432-0584

pii

10.1007/s00277-018-3341-6

journal_volume

pub_type

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