Bloodstream Infections in Patients with Hematologic Diseases: Causative Organisms and Factors Associated with Resistance
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Background: Patients with hematologic diseases are at high risk of bloodstream infections (BSIs). This study aimed to analyze clinical features and distributions of microorganisms in patients with hematologic diseases presenting at a tertiary care university-affiliated hospital in Korea. Materials and methods: We retrospectively reviewed all BSI episodes recorded in patient medical records at two hematologic wards of the Catholic Hematology Hospital from January to December 2020. Our aim was to analyze demographic and clinical characteristics relevant to BSIs. We also described the antimicrobial resistance patterns of the major pathogens identified in this study, and evaluated risk factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae isolates and for vancomycin resistance in enterococcal isolates. Results: A total of 380 BSI episodes were identified in 334 patients over the course of 1 year (monomicrobial BSI episodes, 86.1%; polymicrobial BSI episodes, 13.9%). Gram-negative bacteria accounted for 242 isolates (54.8%). The most frequently isolated Gram-negative bacteria isolates were Escherichia coli (107 [24.2%]) followed by Klebsiella spp. (72 [16.3%]), Pseudomonas spp. (21 [4.8%]), and Enterobacter spp. (12 [2.7%]). The most commonly identified Gram-positive bacteria were Enterococcus spp. (72 [16.3%]) followed by viridans streptococci (54 [12.2%]), coagulase-negative staphylococci (CoNS) (24 [5.4%]), and Corynebacterium spp. (22 [5.0%]). ESBL-producing Enterobacteriaceae accounted for 25.1% of the total distribution. Among 54 Enterococcus faecium isolates, 100.0% were resistant to ampicillin and 55.6% showed resistance to vancomycin, while 100.0% (n = 12) of Enterococcus faecalis isolates were susceptible to ampicillin and vancomycin, respectively. Use of ciprofloxacin prophylaxis (odds ratio: 5.20; 95% confidence interval: 1.11 - 24.34; P = 0.04) was an independent risk factor for ESBL production in Enterobacteriaceae BSIs. Conclusion: Compared with the results of a previous study conducted at the same institution, our findings demonstrated that Gram-negative bacteria remained dominant pathogens in BSIs occurring in patients with hematologic diseases. Our findings also demonstrated a comparatively decreased prevalence of ESBL-producing Enterobacteriaceae in the evaluated BSIs. However, the prevalence of enterococcal BSIs had not decreased, and the proportion of vancomycin-resistant Enterococcus isolates from E. faecium BSIs had increased. In addition, we found that ciprofloxacin prophylaxis was statistically significantly associated with ESBL production in Enterobacteriaceae BSIs. We conclude that, in order to avoid critical complications and to reduce the burden of antimicrobial-resistant organisms in patients with hematologic diseases, it is necessary to conduct periodic examinations evaluating changes in BSI epidemiology within a single medical center.
Abstract
Background: Patients with hematologic diseases are at high risk of bloodstream infections (BSIs). This study aimed to analyze clinical features and distributions of microorganisms in patients with hematologic diseases presenting at a tertiary care university-affiliated hospital in Korea. Materials and methods: We retrospectively reviewed all BSI episodes recorded in patient medical records at two hematologic wards of the Catholic Hematology Hospital from January to December 2020. Our aim was to analyze demographic and clinical characteristics relevant to BSIs. We also described the antimicrobial resistance patterns of the major pathogens identified in this study, and evaluated risk factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae isolates and for vancomycin resistance in enterococcal isolates. Results: A total of 380 BSI episodes were identified in 334 patients over the course of 1 year (monomicrobial BSI episodes, 86.1%; polymicrobial BSI episodes, 13.9%). Gram-negative bacteria accounted for 242 isolates (54.8%). The most frequently isolated Gram-negative bacteria isolates were Escherichia coli (107 [24.2%]) followed by Klebsiella spp. (72 [16.3%]), Pseudomonas spp. (21 [4.8%]), and Enterobacter spp. (12 [2.7%]). The most commonly identified Gram-positive bacteria were Enterococcus spp. (72 [16.3%]) followed by viridans streptococci (54 [12.2%]), coagulase-negative staphylococci (CoNS) (24 [5.4%]), and Corynebacterium spp. (22 [5.0%]). ESBL-producing Enterobacteriaceae accounted for 25.1% of the total distribution. Among 54 Enterococcus faecium isolates, 100.0% were resistant to ampicillin and 55.6% showed resistance to vancomycin, while 100.0% (n = 12) of Enterococcus faecalis isolates were susceptible to ampicillin and vancomycin, respectively. Use of ciprofloxacin prophylaxis (odds ratio: 5.20; 95% confidence interval: 1.11 - 24.34; P = 0.04) was an independent risk factor for ESBL production in Enterobacteriaceae BSIs. Conclusion: Compared with the results of a previous study conducted at the same institution, our findings demonstrated that Gram-negative bacteria remained dominant pathogens in BSIs occurring in patients with hematologic diseases. Our findings also demonstrated a comparatively decreased prevalence of ESBL-producing Enterobacteriaceae in the evaluated BSIs. However, the prevalence of enterococcal BSIs had not decreased, and the proportion of vancomycin-resistant Enterococcus isolates from E. faecium BSIs had increased. In addition, we found that ciprofloxacin prophylaxis was statistically significantly associated with ESBL production in Enterobacteriaceae BSIs. We conclude that, in order to avoid critical complications and to reduce the burden of antimicrobial-resistant organisms in patients with hematologic diseases, it is necessary to conduct periodic examinations evaluating changes in BSI epidemiology within a single medical center.
참고문헌 (35)
- Mikulska M, "Blood stream infections in allogeneic hematopoietic stem cell transplant recipients : reemergence of Gram-negative rods and increasing antibiotic resistance", Biol Blood Marrow Transplant, 15, pp.47~53 (2009)
- Scheich S, "Bloodstream infections with gram-negative organisms and the impact of multidrug resistance in patients with hematological malignancies", Ann Hematol, 97, pp.2225~2234 (2018)
- 이동건, "Evidence-Based Guidelines for Empirical Therapy of Neutropenic Fever in Korea", The Korean Journal of Internal Medicine, 26(2), pp.220~252 (2011), 대한내과학회
- Carvalho AS, "Bloodstream infections in neutropenic patients with haematological malignancies", Infect Dis Health, 25, pp.22~29 (2020)
- Sung Min Jung, "Cancer patients with neutropenic septic shock: etiology and antimicrobial resistance", The Korean Journal of Internal Medicine, 35(4), pp.979~987 (2020), 대한내과학회[DOI]
- Finello M, "Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients", Rev Argent Microbiol, 53, pp.183~193 (2021)
- Haddad S, "Bacterial bloodstream infections and patterns of resistance in patients with haematological malignancies at a tertiary centre in Lebanon over 10 years", J Glob Antimicrob Resist, 27, pp.228~235 (2021)
- Kern WV, "Impact of fluoroquinolone prophylaxis during neutropenia on bloodstream infection : Data from a surveillance program in 8755 patients receiving high-dose chemotherapy for haematologic malignancies between 2009 and 2014", J Infect, 77, pp.68~74 (2018)
- Mert D, "Epidemiology and mortality in bacterial bloodstream infections in patients with hematologic malignancies", J Infect Dev Ctries, 13, pp.727~735 (2019)
- Cattaneo C, "Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients : results of a prospective study by the Rete Ematologica Lombarda(Rel)", Ann Hematol, 95, pp.1955~1963 (2016)
- Kang CI, "Risk factors for infection and treatment outcome of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy", Ann Hematol, 91, pp.115~121 (2012)
- 권재철, "Epidemiology and Clinical Features of Bloodstream Infections in Hematology Wards: One Year Experience at the Catholic Blood and Marrow Transplantation Center", Infection and Chemotherapy, 45(1), pp.51~61 (2013), 대한감염학회[DOI]
- Liang T, "Epidemiology, risk factors, and clinical outcomes of bloodstream infection due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in hematologic malignancy : A retrospective study from Central South China", Microb Drug Resist, 27, pp.800~808 (2021)
- Trecarichi EM, "Bloodstream infections caused by Escherichia coli in onco-haematological patients : Risk factors and mortality in an Italian prospective survey", PLoS One, 14, pp.e0224465~ (2019)
- 조성진, "Direct Identification and Antimicrobial Susceptibility Testing of Bacteria From Positive Blood Culture Bottles by Matrix-Assisted Laser Desorption", Ionization Time-of-Flight Mass Spectrometry and the Vitek 2 System, 2016, pp.36(2), 117~123[DOI]
- 조성연, "Comparison of Enterococcus faecium Bacteremic Isolates from Hematologic and Non-hematologic Patients: Differences in Antimicrobial Resistance and Molecular Characteristics", Annals of Laboratory Medicine, 38(3), pp.226~234 (2018), 대한진단검사의학회[DOI]
- Yang M, "Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies", PLoS One, 14, pp.e0225765~ (2019)
- Freifeld AG, "Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer : 2010 Update by the Infectious Diseases Society of America", Clin Infect Dis, 52, pp.427~431 (2011)
- Al-Otaibi FE, "Prevalence and risk factors of Gram-negative bacilli causing blood stream infection in patients with malignancy", Saudi Med J, 37, pp.979~984 (2016)
- WisplinghoffH, "Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States", Clin Infect Dis, 36, pp.1103~1110 (2003)
- Hazan G, "Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia", J Pediatr Hematol Oncol, 36, pp.e275~e279 (2014)
- Chen S, "Evaluation of inflammatory biomarkers in pediatric hematologyoncology patients with bloodstream infection", J Pediatr Hematol Oncol, 43, pp.e596~e600 (2021)
- Kantarjian H, "Blinatumomab versus chemotherapy for advanced acute lymphoblastic leukemia", N Engl J Med, 376, pp.836~847 (2017)
- Kantarjian HM, "Inotuzumab ozogamicin versus standard therapy for acute lymphoblastic leukemia", N Engl J Med, 375, pp.740~753 (2016)
- Garcia-Vidal C, "Risk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance", PLoS One, 13, pp.e0199531~ (2018)
- Ha YE, "Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with cancer", Int J Antimicrob Agents, 42, pp.403~409 (2013)
- Gudiol C, "Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli(ESBL-EC)in cancer patients : clinical features, risk factors, molecular epidemiology and outcome", J Antimicrob Chemother, 65, pp.333~341 (2010)
- Trecarichi EM, "Incidence and clinical impact of extended-spectrum-beta-lactamase(ESBL)production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies", J Infect, 58, pp.299~307 (2009)
- Garnica M, "Ciprofloxacin prophylaxis in high risk neutropenic patients : effects on outcomes, antimicrobial therapy and resistance", BMC Infect Dis, 13, pp.356~ (2013)
- Paterson DL, "Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia", Clin Infect Dis, 30, pp.473~478 (2000)
- Park SH, "Emergence of community-associated methicillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated bloodstream infections in Korea", Infect Control Hosp Epidemiol, 30, pp.146~155 (2009)
- Choi Seong-Ho, "A Longitudinal Study of Adult Patients with Staphylococcus aureus Bacteremia over 11 Years in Korea", Journal of Korean Medical Science, 36(16), pp.1~13 (2021), 대한의학회[DOI]
- Cho SY, "Impact of vancomycin resistance on mortality in neutropenic patients with enterococcal bloodstream infection : a retrospective study", BMC Infect Dis, 13, pp.504~ (2013)
- Huang CT, "Risk factors and characteristics of blood stream infections in patients with newly diagnosed multiple myeloma", BMC Infect Dis, 17, pp.33~ (2017)
- Okamoto A, "Predictive and risk factor analysis for bloodstream infection in high-risk hematological patients with febrile neutropenia : post-hoc analysis from a prospective, large-scale clinical study", Int J Hematol, 114, pp.472~482 (2021)