Impact of multidrug resistance in cancer patients with bloodstream infections caused by Gram-negative bacilli: results from a multicentre study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objective To evaluate the impact of multidrug resistance (MDR) on the mortality of cancer patients with bloodstream infection (BSI) by Gram-negative bacilli (GNB). Patients and methods This was a prospective observational multicentre study including cancer patients with BSI caused by GNB (June 2018–January 2020). The primary outcome was 30-day mortality. The secondary outcome was mortality attributable to MDR organisms, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant (CR) Enterobacterales and CR non-fermenting GNB (CR-NFGNB). A multivariable regression analysis identified factors associated with 30-day mortality. Adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) were calculated. Attributable mortality was estimated according to DRIVE-AB Consortium’s formula. Results Of 347 cancer patients, 232 (66.9%) had BSI caused by MDR-GNB. Thirty-day mortality was 27.2% in patients with BSI caused by MDR organisms compared to 7% in those with BSI by susceptible GNB (P < 0.001). In the multivariable analysis, MDR-GNB including ESBL-producing Enterobacterales (aOR 8.734, 95% CI 1.411–54.077, P = 0.02), KPC-producing Enterobacterales (aOR 8.548, 95% CI 1.296–56.411, P = 0.026), metallo-β-lactamases (MBL)-producing Enterobacterales (aOR 15.802, 95% CI 1.408–68.667, P = 0.022) and CR-NFGNB (aOR 53.373, 95% CI 5.104–89.146, P < 0.001) as compared to susceptible GNB were independently associated with 30-day mortality. Mortality attributable to MDR-GNB was 43%. According to causative pathogens, attributable mortality was 33% in ESBL, 32% in KPC, 47% in MBL and 73% in CR-NFGNB. Conclusions In cancer patients, BSIs due to MDR-GNB are associated with excess mortality compared to BSI by susceptible GNB. Strategies to reduce the spread of MDR-GNB and to promote optimal management of affected patients are urgently needed.
Source: JAC-Antimicrobial Resistance
Authors: Marco Falcone, Sergio Carbonara, Andrea Marino, Giovanni Di Caprio, Anna Carretta, Alessandra Mularoni, Michele Fabiano Mariani, Alberto Enrico Maraolo, Lidia Dalfino, Lorenzo Corbo, Alice Annalisa Medaglia, Christian Sgroi, Rosa Fontana Del Vecchio, Giancarlo Ceccarelli, Antonio Albanese, Calogero Buscemi, Simona Talamanca, Giuseppe Foti, Antonina Franco, Carmelo Iacobello, Salvatore Corrao, Domenico Morana, Filippo Pieralli, Ivan Gentile, Teresa Santantonio, Antonio Cascio, Nicola Coppola, Bruno Cacopardo, Mario Venditti, Francesco Menichetti, Giusy Tiseo
Institutions: University of Pisa, Azienda Ospedaliera Universitaria Pisana, University of Catania, Ospedale Garibaldi, University of Foggia, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Bari Aldo Moro, Federico II University Hospital, University of Naples Federico II, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Azienda Ospedaliero-Universitaria Careggi, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, Sapienza University of Rome, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, University of Palermo, Azienda ospedaliera "Bianchi-Melacrino-Morelli", Ospedale Cannizzaro, University of Campania "Luigi Vanvitelli"
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,609
Funder: Mount Sylvia Diatomite
OpenAlex ID: W4412057104