The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections
Linli Lu,1 Cong Xu,1 Yishu Tang,2 Liwen Wang,1 Qian Cheng,1 Xin Chen,1 Jian Zhang,1 Ying Li,1 Han Xiao,1 Xin Li1 1Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Emergency, The Third Xiangya Hospital, Central...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-06-01
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| Series: | Infection and Drug Resistance |
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| Online Access: | https://www.dovepress.com/the-threat-of-carbapenem-resistant-gram-negative-bacteria-in-patients--peer-reviewed-fulltext-article-IDR |
| _version_ | 1811345280365232128 |
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| author | Lu L Xu C Tang Y Wang L Cheng Q Chen X Zhang J Li Y Xiao H Li X |
| author_facet | Lu L Xu C Tang Y Wang L Cheng Q Chen X Zhang J Li Y Xiao H Li X |
| author_sort | Lu L |
| collection | DOAJ |
| description | Linli Lu,1 Cong Xu,1 Yishu Tang,2 Liwen Wang,1 Qian Cheng,1 Xin Chen,1 Jian Zhang,1 Ying Li,1 Han Xiao,1 Xin Li1 1Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Xin Li, Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China, Tel/Fax +86-731-88618241, Email lixiner1975@163.comBackground: Carbapenem-resistant Gram-negative bacteria (CRGNB) bloodstream infection (BSI) pose a significant threat to the prognosis of hematologic malignancies (HM) patients. Understanding the distribution of pathogenic bacteria, changes in carbapenem-resistant trends, risk factors for CRGNB infections, and exploring the early detection measures can help reduce mortality.Methods: We conducted a multicenter retrospective study of Gram-negative bacteria (GNB) BSI in patients with HM in three university-affiliated hospitals in Hunan Province, China, from January 2010 to December 2020. Demographic and clinical data were collected from the hospital electronic medical records system.Results: CRGNB caused 138 (15.3%) of 902 GNB BSI. The detection rate of CRGNB increased from 6.4% in 2010– 2012 to 35.4% in 2019– 2020. The 7-day mortality rate was significantly higher in patients with CRGNB BSI than in patients with carbapenem-susceptible Gram-negative bacteria (CSGNB) BSI [31.9% (44/138) vs 9.7% (74/764), P < 0.001], and the mortality rate in patients with carbapenem-resistant non-fermenting bacteria (CRNFB) bloodstream infections was generally higher than that of carbapenem-resistant Enterobacteriaceae (CRE). Urinary catheter (OR, 2.814; CI=1.395– 5.680; P=0.004) and prior exposure to carbapenem (OR, 4.372; CI=2.881– 6.635; P< 0.001) were independent risk factors for CRGNB BSI. Analysis of co-infections showed that 50%– 85% of patients with CRGNB BSI had pulmonary infections, sputum culture results suggested that sputum culture positivity rate was as high as 57.1%– 66.7% in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) and Stenotrophomonas maltophilia BSI, and the results of antimicrobial susceptibility testing of sputum cultures were consistent with the blood cultures.Conclusion: Carbapenem resistance has dramatically increased in HM patients with GNB BSI in recent years and is associated with a worse outcome, especially for non-fermenting bacteria. In high-risk patients, early screening of the respiratory tract specimens may help to detect CRNFB colonization and protect patients from breakthrough BSI.Keywords: hematological malignancies, carbapenem-resistant, gram-negative bacteria, bloodstream infections, non-fermentative bacteria |
| first_indexed | 2024-04-13T20:00:48Z |
| format | Article |
| id | doaj.art-f649823604b24f45aa88fa4f0ba97cf1 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-04-13T20:00:48Z |
| publishDate | 2022-06-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-f649823604b24f45aa88fa4f0ba97cf12022-12-22T02:32:12ZengDove Medical PressInfection and Drug Resistance1178-69732022-06-01Volume 152901291475743The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream InfectionsLu LXu CTang YWang LCheng QChen XZhang JLi YXiao HLi XLinli Lu,1 Cong Xu,1 Yishu Tang,2 Liwen Wang,1 Qian Cheng,1 Xin Chen,1 Jian Zhang,1 Ying Li,1 Han Xiao,1 Xin Li1 1Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Xin Li, Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China, Tel/Fax +86-731-88618241, Email lixiner1975@163.comBackground: Carbapenem-resistant Gram-negative bacteria (CRGNB) bloodstream infection (BSI) pose a significant threat to the prognosis of hematologic malignancies (HM) patients. Understanding the distribution of pathogenic bacteria, changes in carbapenem-resistant trends, risk factors for CRGNB infections, and exploring the early detection measures can help reduce mortality.Methods: We conducted a multicenter retrospective study of Gram-negative bacteria (GNB) BSI in patients with HM in three university-affiliated hospitals in Hunan Province, China, from January 2010 to December 2020. Demographic and clinical data were collected from the hospital electronic medical records system.Results: CRGNB caused 138 (15.3%) of 902 GNB BSI. The detection rate of CRGNB increased from 6.4% in 2010– 2012 to 35.4% in 2019– 2020. The 7-day mortality rate was significantly higher in patients with CRGNB BSI than in patients with carbapenem-susceptible Gram-negative bacteria (CSGNB) BSI [31.9% (44/138) vs 9.7% (74/764), P < 0.001], and the mortality rate in patients with carbapenem-resistant non-fermenting bacteria (CRNFB) bloodstream infections was generally higher than that of carbapenem-resistant Enterobacteriaceae (CRE). Urinary catheter (OR, 2.814; CI=1.395– 5.680; P=0.004) and prior exposure to carbapenem (OR, 4.372; CI=2.881– 6.635; P< 0.001) were independent risk factors for CRGNB BSI. Analysis of co-infections showed that 50%– 85% of patients with CRGNB BSI had pulmonary infections, sputum culture results suggested that sputum culture positivity rate was as high as 57.1%– 66.7% in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) and Stenotrophomonas maltophilia BSI, and the results of antimicrobial susceptibility testing of sputum cultures were consistent with the blood cultures.Conclusion: Carbapenem resistance has dramatically increased in HM patients with GNB BSI in recent years and is associated with a worse outcome, especially for non-fermenting bacteria. In high-risk patients, early screening of the respiratory tract specimens may help to detect CRNFB colonization and protect patients from breakthrough BSI.Keywords: hematological malignancies, carbapenem-resistant, gram-negative bacteria, bloodstream infections, non-fermentative bacteriahttps://www.dovepress.com/the-threat-of-carbapenem-resistant-gram-negative-bacteria-in-patients--peer-reviewed-fulltext-article-IDRhematological malignanciescarbapenem-resistantgram-negative bacteriabloodstream infectionsnon-fermentative bacteria |
| spellingShingle | Lu L Xu C Tang Y Wang L Cheng Q Chen X Zhang J Li Y Xiao H Li X The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections Infection and Drug Resistance hematological malignancies carbapenem-resistant gram-negative bacteria bloodstream infections non-fermentative bacteria |
| title | The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections |
| title_full | The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections |
| title_fullStr | The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections |
| title_full_unstemmed | The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections |
| title_short | The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections |
| title_sort | threat of carbapenem resistant gram negative bacteria in patients with hematological malignancies unignorable respiratory non fermentative bacteria derived bloodstream infections |
| topic | hematological malignancies carbapenem-resistant gram-negative bacteria bloodstream infections non-fermentative bacteria |
| url | https://www.dovepress.com/the-threat-of-carbapenem-resistant-gram-negative-bacteria-in-patients--peer-reviewed-fulltext-article-IDR |
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