Clinical characteristics and prognosis of bloodstream infections with carbapenem-resistant Gram-negative organisms in patients with hematological malignancies: A multicenter case-control study in China
Year: 2024
Type: article
Study design: Observational Study
Abstract: Objective To investigate clinical characteristics of hematological malignancy (HM) patients with carbapenem-resistant gram-negative organism (CRO) bloodstream infections (BSI) in China, and to elucidate the prognostic risk factors of CRO BSI. Methods We conducted a multicenter case-control study of 201 HM patients with CRO BSI between 2018–2020. Antimicrobial susceptibility testing and whole genome sequencing were performed for CRO isolates. Independent risk factors for 28-day crude mortality were analyzed using Cox proportional hazards regression models. The subgroups of major species were also evaluated. Results The pathogens responsible for CRO BSI in HM patients dominated by ST11 CRKP, ST167 CREC and ST463 CRPA. Most isolates produced carbapenemases with KPC and NDM being the main. CRO isolates had resistance rates to conventional antimicrobials ranging from 55%−100% and poor susceptibility to novel antimicrobials related to carbapenemases and species. The 28-day crude mortality was 24.2%. Non-Hodgkin lymphoma, heart disease, bla KPC-2 positive, empirical antibiotic therapy with linezolid, Pitt bacteremia score >3.5 were risk factors for 28-day mortality and appropriate definitive antibiotic therapy, tigecycline-containing therapy and aminoglycoside-containing therapy were protective factors. bla KPC-2 positive in CRKP and ST463 in CRPA were associated with Pitt bacteremia score >3.5. Solid tumor and other site infections before BSI were risk factors for ST463 CRPA BSI and pulmonary infection before BSI was risk factor for KPC-KP BSI. Conclusions The antimicrobial resistance of CRO isolates for BSI in HM patients is critical. HM patients with CRO BSI should be treated with appropriate definitive antibiotic therapy based on early clarification of pathology and their antimicrobial susceptibility.
Source: Journal of Infection
Authors: Junxin Zhou, Jian Sun, Shanshan Lu, Xinhong Han, Jintao He, Ping Zhang, Huangdu Hu, Yuke Zhang, Yanfei Wang, Qin Yang, Shujuan Ji, Zhihui Zhou, Xiaoting Hua, Xueqing Wu, Yan Jiang, Xiaoxing Du, Yunsong Yu
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,030
Funders: Wenzhou Medical University, Harbin Medical University, Innovative Research Group Project of the National Natural Science Foundation of China, Sir Run Run Shaw Hospital, National Natural Science Foundation of China, Sun Yat-sen University, Tongji University, Zhejiang University, Sichuan University, China Medical University, Soochow University, Hebei Medical University, Shandong First Medical University, Ruijin Hospital, National Key Research and Development Program of China, West China Hospital, Sichuan University, Medical Science and Technology Project of Zhejiang Province, Natural Science Foundation of Zhejiang Province
OpenAlex ID: W4403777122