Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Caglayan Merve Ayaz; Gulsen Hazırolan; Banu Sancak; Gulsen Hascelik; Murat Akova

doi:10.36519/idcm.2022.141

Factors Associated with Gram-Negative Bacteremia and Mortality in Neutropenic Patients with Hematologic Malignancies in a High-Resistance Setting

Infect Dis Clin Microbiol. 2022 Jun 13;4(2):87-98. doi: 10.36519/idcm.2022.141. eCollection 2022 Jun.

Authors

Caglayan Merve Ayaz¹, Gulsen Hazırolan², Banu Sancak², Gulsen Hascelik², Murat Akova³

Affiliations

¹ Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey.
² Department of Medical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey.
³ Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey.

Abstract

Objective: Patients with hematological malignancies (HMs) have a substantial incidence of febrile neutropenic episodes. Gram-negative bacteremia (GNB) is still the major cause of these episodes. We evaluated the factors associated with GNB and mortality of bacteremic patients with HMs in a high-resistance setting.

Materials and methods: We conducted a prospective cohort study from March 2018 to June 2019 with 66 bacteremic and 132 non-bacteremic patients. Regression analyses were used to identify factors associated with GNB and 30-day mortality.

Results: The mean age was 53.83±15.21 years, and 129 (65.2%) of the patients were male. In multivariable analysis, factors independently associated with GNB were male gender, duration of hospitalization and neutropenia before the febrile neutropenic episode, leukemias and allogeneic transplant recipients, radiotherapy, receiving glucocorticosteroids, colonization with resistant microorganisms. All-cause mortality and 30-day mortality were 47.0% and 30.3% in cases of GNB, compared to non-bacteremic controls 25.0% and 10.6%, respectively. Sepsis, duration of hospitalization before the febrile neutropenic episode, carbapenem-resistant GNB, and inappropriate empirical antibiotic treatment was found as factors associated with 30-day mortality. Prior antibiotic exposure particularly beta-lactamase inhibitor combinations and carbapenems during the past 30 days was more frequent in the bacteremic group. An increasing trend was observed in multidrug-resistant (MDR) bacteria (p=0.03) and carbapenem-resistant Enterobacterales (p=0.02) over the years.

Conclusion: By considering the risk factors associated with GNB and 30-day mortality that we detected in our study among neutropenic patients, a personalized approach for the management of febrile neutropenic patients can be designed by means of an effective antimicrobial stewardship program including the appropriate use of broad-spectrum antibiotics.

Keywords: Bacteremia; Gram-negative bacteria; anti-bacterial agents; febrile neutropenia; hematological neoplasms.