A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Shaozhen Chen; Kangni Lin; Qian Li; Xiaofeng Luo; Min Xiao; Minmin Chen; Haojie Zhu; Yongquan Chen; Xueqiong Wu; Yanling Zeng; Yuxin Zhang; Issa Hajji Ally; Jingjing Xu; Jinhua Ren; Zhizhe Chen; Jianda Hu; Ting Yang

doi:10.7150/jca.50802

A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

J Cancer. 2021 Jul 25;12(18):5494-5505. doi: 10.7150/jca.50802. eCollection 2021.

Authors

Shaozhen Chen¹, Kangni Lin¹, Qian Li¹, Xiaofeng Luo¹, Min Xiao^{1

2}, Minmin Chen¹, Haojie Zhu¹, Yongquan Chen^{1

3}, Xueqiong Wu¹, Yanling Zeng^{1

4}, Yuxin Zhang^{1

5}, Issa Hajji Ally¹, Jingjing Xu¹, Jinhua Ren¹, Zhizhe Chen¹, Jianda Hu¹, Ting Yang¹

Affiliations

¹ Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China.
² Department of Cancer, Fujian Provincial Cancer Hospital, Fuzhou 350014, Fujian, P. R. China.
³ Department of Hematology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, Fujian, P. R. China.
⁴ Department of Hematology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian, P.R. China.
⁵ Department of Hematology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen 361015, Fujian, P.R. China.

Abstract

Background: Bloodstream infection (BSI) is a common and serious complication after patients with hematologic malignancies (HM) receiving chemotherapy. This study examined real-world data seeking to characterize HM BSI and identify risk factors for BSI emergence and mortality. Methods: We retrospectively analyzed the pathogenic epidemiology, antibiotic resistance, and BSI risk factors in a single-center cohort including 3014 consecutive patients with HM receiving chemotherapy between 2013 and 2016. Results of the pathogenic epidemiology were validated via comparison to available reported data. Results: We found that 725 patients (24.1%) had BSIs. Gram-negative (G-) bacteria represented 64.7% of the 744 isolated pathogenic strains, while Gram-positive (G+) bacteria and fungi accounted for 27.7% and 7.7% of the BSIs, respectively. The most common isolates were Klebsiella pneumoniae (19.2%), and 95.1% of the multidrug-resistant strains (MDR) were extended-spectrum beta-lactamase producing strains. G- bacteria were the main microflora responsible for BSI in our cohort of Chinese HM patients compared to studies in developed countries or in neutropenic children with HM or solid tumors. Multivariate analysis revealed that male sex, age ≥ 45 and < 65 yr, hospital length of stay ≥ 9d, neutropenia ≥ 7d before cultures, ≥ 2 antibiotics, and infections (gastrointestinal, perirectal, or urinary tract) independently predicted BSI emergence. Furthermore, age ≥ 65 yr, neutropenia ≥ 7d before blood cultures, no HM remission, lower white blood cell count, ≥ 3 antibiotics, respiratory infections, and Acinetobacter baumannii and Stenotrophomonas maltophilia BSI were independent predictors of 30-day mortality. Conclusions: G- bacteria were the predominant microflora during the study period and antibiotic resistance levels of the pathogens detected were high, especially for MDR strains. The mortality of BSI patients was high in this large cohort. Close attention should be paid to the risk factors identified here to facilitate timely and effective clinical management of such patients.

Keywords: Bloodstream infections; hematological malignancy; pathogen; resistance; risk factor.