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MacPhail A, Dendle C, Slavin M, McQuilten Z. Hospital-acquired bloodstream infections in patients with cancer: current knowledge and future directions. J Hosp Infect 2024; 148:39-50. [PMID: 38490489 DOI: 10.1016/j.jhin.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety.
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Affiliation(s)
- A MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Infectious Diseases, Monash Health, Melbourne, Australia
| | - C Dendle
- Department of Infectious Diseases, Monash Health, Melbourne, Australia; School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Z McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Haematology, Monash Health, Clayton, Australia.
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Choi H, Choi MH, Kim D, Lee KH, Jeong SH. Shifting trends in bloodstream infection-causing microorganisms and their clinical impact in patients with haematologic malignancies in South Korea: A propensity score-matched study. Int J Antimicrob Agents 2024:107212. [PMID: 38795932 DOI: 10.1016/j.ijantimicag.2024.107212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND This study aimed to identify recent trends in the epidemiology of bloodstream infection (BSI)-causing microorganisms among patients with haematologic malignancies (HMs) between 2011 to 2021, and to determine their impact on patient outcomes. METHODS This retrospective study included 6792 patients with HMs, of whom 1308 (19.3%) developed BSI within 1 year of diagnosis. The incidence of BSI-causing microorganisms was determined, and a propensity score-matched study was performed to identify risk factors for 28-day all-cause mortality (ACM) in patients with HM. RESULTS A total of 6792 patients with HMs were enrolled. The cumulative incidence of BSI and neutropenia was significantly higher in the acute myeloid leukaemia and acute lymphoblastic leukaemia groups compared to other groups, and neutropenia and type of HMs were risk factors for the development of BSI. The annual incidence of coagulase-negative staphylococci (CoNS)-BSI decreased significantly (p<0.001), whereas Klebsiella pneumoniae-BSI increased (p=0.01). Carbapenem nonsusceptibility rates in K. pneumoniae isolates increased from 0.0% to 76.5% (p<0.001). BSI caused by K. pneumoniae [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.12-4.21] was associated with higher 28-day ACM compared to that caused by CoNS (aOR 0.86; 95% CI 0.48-1.55). CONCLUSION The pathogenic spectrum of BSI-causing bacteria in patients with HMs gradually shifted from gram-positive to gram-negative, especially from CoNS to K. pneumoniae. Considering that K. pneumoniae-BSI had a significantly higher 28-day mortality rate than CoNS-BSI, this evolving trend could adversely impact clinical outcomes of patients with HMs.
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Affiliation(s)
- Heekang Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital; and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Min Hyuk Choi
- Department of Laboratory Medicine, Gangnam Severance Hospital; and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea.
| | - Dokyun Kim
- Department of Laboratory Medicine, Gangnam Severance Hospital; and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Gangnam Severance Hospital; and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
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Watanabe N, Koyama S, Maeda T, Karaushi H, Taji Y, Kawasaki Y, Takahashi N, Mitsutake K, Ebihara Y. Direct Species Identification in Positive Blood Culture Bottles From Patients With Hematologic Malignancies. Cureus 2024; 16:e59043. [PMID: 38800333 PMCID: PMC11128060 DOI: 10.7759/cureus.59043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background In patients with hematologic malignancies, faster species identification is particularly important in the management of bloodstream infection because of their immunocompromised and neutropenic status. In the present study, we analyzed direct species identification in patients with hematologic malignancies, and the factors that might influence the results of species identification. Methods We performed direct species identification using a Sepsityper® kit (Bruker Corporation, Billerica, Massachusetts, United States) and compared the results with a conventional method in patients with hematologic malignancies. Forty-five positive blood culture bottles containing single microorganisms from 37 patients were analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). And patients' clinical data were compared between the groups with spectral scores at acceptable and unacceptable levels. Results Direct species identification correctly identified 42 of 45 isolates and three were misidentified. While 35 of 45 isolates showed a spectral score ≥1.7 (acceptable identification), 10 isolates had a spectral score <1.7 (unacceptable identification) including three misidentified isolates. The group with a spectral score ≥1.7 had significantly lower white blood cell (p<0.01), neutrophil (p<0.01), and platelet (p<0.01) counts in addition to more frequent central venous (CV) line insertion (p=0.01). Multivariate analysis revealed that pathogen type (gram-positive or negative) and CV line insertion were associated with spectral scores. Conclusion Direct species identification using the Sepsityper kit is an upcoming approach for blood culture bottles, which were flagged as positive even in patients with hematologic malignancies when the spectral score was ≥ 1.7. Our study also indicates that direct identification is more accurate in patients with CV lines, and may be less accurate when gram-positive bacteria are detected.
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Affiliation(s)
- Noriyuki Watanabe
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Sachie Koyama
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Tomoya Maeda
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Haruka Karaushi
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yoshitada Taji
- Clinical Laboratory, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yohei Kawasaki
- Department of Biostatistics, Graduate School of Medicine, Saitama Medical University, Saitama, JPN
| | - Naoki Takahashi
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yasuhiro Ebihara
- Department of Laboratory Medicine, Saitama Medical University International Medical Center, Saitama, JPN
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Royo-Cebrecos C, Laporte-Amargós J, Peña M, Ruiz-Camps I, Garcia-Vidal C, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Morales HMP, Brunel AS, García E, Isler B, Kern WV, Palacios-Baena ZR, de la Calle GM, Montero MM, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatii P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, Carratalà J, Gudiol C. Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy. Microorganisms 2024; 12:705. [PMID: 38674650 PMCID: PMC11051800 DOI: 10.3390/microorganisms12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.
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Affiliation(s)
- Cristina Royo-Cebrecos
- Internal Medicine Department, Hospital Nostra Senyora de Meritxell, SAAS, AD700 Escaldes-Engordany, Andorra;
| | - Júlia Laporte-Amargós
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
| | - Marta Peña
- Haematology Department, Institute Català d’Oncologia (ICO)–Hospital Duran i Reynals, IDIBELL, 08908 Barcelona, Spain;
| | - Isabel Ruiz-Camps
- Infectious Diseases Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic i Provincial, 08036 Barcelona, Spain;
| | - Edson Abdala
- Instituto do Cancer do Estado de São Paulo, Faculty of Medicine, Univesity of São Paulo, Sao Paulo 01246, Brazil;
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, 06100 Ankara, Turkey;
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, 48903 Bilbao, Spain;
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Ospedale Policlinico San Martino, University of Genoa (DISSAL), 16132 Genoa, Italy;
| | - Pilar Martín-Dávila
- Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain;
| | - Fabián Herrera
- Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1430EFA, Argentina;
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Lubos Drgona
- Oncohematology Department, National Cancer Institute, Comenius University, 81499 Bratislava, Slovakia;
| | | | - Anne-Sophie Brunel
- Infectious Diseases and Medicine Department, Lausanne University Hospital, CHUV, 1011 Lausanne, Switzerland;
| | - Estefanía García
- Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain;
| | - Burcu Isler
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, 34668 Istanbul, Turkey;
| | - Winfried V. Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg Medical Center, 79110 Freiburg, Germany;
| | - Zaira R. Palacios-Baena
- Unit of Infectious Diseases and Clinical Microbiology, Institute of Biomedicine of Seville (IBIS), Virgen Macarena University Hospital, 41013 Seville, Spain;
| | - Guillermo Maestr de la Calle
- Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i + 12), School of Medicine, “12 de Octubre” University Hospital, Universidad Complutense, 28041 Madrid, Spain;
| | - Maria Milagro Montero
- Infectious Pathology and Antimicrobials Research Group (IPAR), Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Souha S. Kanj
- Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon;
| | - Oguz R. Sipahi
- Faculty of Medicine, Ege University, 35040 Izmir, Turkey;
| | - Sebnem Calik
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, 35170 Izmir, Turkey;
| | | | - Jorge I. Marin
- Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Manizales 170001-17, Colombia;
| | - Marisa Z. R. Gomes
- Hospital Federal dos Servidores do Estado, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro 20221-161, Brazil;
| | - Philipp Hemmatii
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany;
| | - Rafael Araos
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago de Chile 12461, Chile;
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21100 Varese, Italy;
| | - Jose L. Del Pozo
- Infectious Diseases and Microbiology Unit, Navarra University Clinic, 31008 Pamplona, Spain;
| | - Lucrecia Yáñez
- Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Robert Tilley
- Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK;
| | - Adriana Manzur
- Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina;
| | - Andrés Novo
- Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
- Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
- Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain
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Lee M, Lee CM, Byun JM, Shin DY, Koh Y, Hong J, Choe PG, Park WB, Kim NJ, Yoon SS, Oh MD, Kang CK, Kim I. Risk factors for resistant gram-positive bacteremia in febrile neutropenic patients with cancer. J Infect Chemother 2024:S1341-321X(24)00097-7. [PMID: 38518846 DOI: 10.1016/j.jiac.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Gram-positive bacteria are frequently resistant to empirical beta-lactams in febrile neutropenic patients with cancer. As microbiology and antibiotic susceptibility changes, we reevaluated the risk factors for resistant Gram-positive bacteremia in febrile neutropenic patients with cancer. METHODS Episodes of bacteremic febrile neutropenia in Seoul National University Hospital from July 2019 to June 2022 were reviewed. Resistant Gram-positive bacteria were defined as a pathogen susceptible only to glycopeptide or linezolid in vitro (e.g., methicillin-resistant staphylococci, penicillin-resistant viridans streptococci, and ampicillin-resistant enterococci). Episodes were compared to identify independent risk factors for resistant Gram-positive bacteremia. RESULTS Of 225 episodes, 78 (34.7%) involved resistant Gram-positive bacteremia. Multivariate analysis revealed that breakthrough bacteremia while being administered antibiotics (adjusted odds ratio [aOR], 6.794; 95% confidence interval [95% CI], 3.130-14.749; P < 0.001) and catheter-related infection (aOR 4.039, 95% CI 1.366-11.946; P = 0.012) were associated with resistant Gram-positive bacteremia. Chronic liver disease (aOR 0.231, 95% CI 0.059-0.905; P = 0.035) and hypotension at bacteremia (aOR 0.454, 95% CI 0.218-0.945; P = 0.035) were inversely associated with resistant Gram-positive bacteremia. CONCLUSIONS Resistant Gram-positive bacteria should be considered in breakthrough bacteremia and catheter-related infection in febrile neutropenic patients with cancer.
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Affiliation(s)
- Minkyeong Lee
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Sardzikova S, Andrijkova K, Svec P, Beke G, Klucar L, Minarik G, Bielik V, Kolenova A, Soltys K. Gut diversity and the resistome as biomarkers of febrile neutropenia outcome in paediatric oncology patients undergoing hematopoietic stem cell transplantation. Sci Rep 2024; 14:5504. [PMID: 38448687 PMCID: PMC10918076 DOI: 10.1038/s41598-024-56242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
The gut microbiota of paediatric oncology patients undergoing a conditioning regimen before hematopoietic stem cell transplantation is recently considered to play role in febrile neutropenia. Disruption of commensal microbiota and evolution of opportune pathogens community carrying a plethora of antibiotic-resistance genes play crucial role. However, the impact, predictive role and association of patient´s gut resistome in the course of the therapy is still to be elucidated. We analysed gut microbiota composition and resistome of 18 paediatric oncology patients undergoing hematopoietic stem cell transplantation, including 12 patients developing febrile neutropenia, hospitalized at The Bone Marrow Transplantation Unit of the National Institute of Children´s disease in Slovak Republic and healthy individuals (n = 14). Gut microbiome of stool samples obtained in 3 time points, before hematopoietic stem cell transplantation (n = 16), one week after hematopoietic stem cell transplantation (n = 16) and four weeks after hematopoietic stem cell transplantation (n = 14) was investigated using shotgun metagenome sequencing and bioinformatical analysis. We identified significant decrease in alpha-diversity and nine antibiotic-resistance genes msr(C), dfrG, erm(T), VanHAX, erm(B), aac(6)-aph(2), aph(3)-III, ant(6)-Ia and aac(6)-Ii, one week after hematopoietic stem cell transplantation associated with febrile neutropenia. Multidrug-resistant opportune pathogens of ESKAPE, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli found in the gut carried the significant subset of patient's resistome. Over 50% of patients treated with trimethoprim/sulfamethoxazole, piperacillin/tazobactam and amikacin carried antibiotic-resistance genes to applied treatment. The alpha diversity and the resistome of gut microbiota one week after hematopoietic stem cell transplantation is relevant predictor of febrile neutropenia outcome after hematopoietic stem cell transplantation. Furthermore, the interindividual diversity of multi-drug resistant opportunistic pathogens with variable portfolios of antibiotic-resistance genes indicates necessity of preventive, personalized approach.
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Affiliation(s)
- Sara Sardzikova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Kristina Andrijkova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Svec
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Gabor Beke
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Lubos Klucar
- Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Viktor Bielik
- Department of Biological and Medical Science, Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia
| | - Alexandra Kolenova
- Department of Paediatric Haematology and Oncology, Children's Haematology and Oncology Clinic and Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Katarina Soltys
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia.
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Maldarelli ME, Noto MJ. The emerging role for neutrophil mitochondrial metabolism in lung inflammation. IMMUNOMETABOLISM (COBHAM, SURREY) 2024; 6:e00036. [PMID: 38283697 PMCID: PMC10810349 DOI: 10.1097/in9.0000000000000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
Recent advances shed light on the importance of mitochondrial metabolism in supporting essential neutrophil functions such as trafficking, NETosis, bacterial killing, and modulating inflammatory responses. Mitochondrial metabolism is now recognized to contribute to a number of lung diseases marked by neutrophilic inflammation, including bacterial pneumonia, acute lung injury, and chronic obstructive pulmonary disease. In this mini review, we provide an overview of neutrophil metabolism focusing on the role of mitochondrial programs, discuss select neutrophil effector functions that are directly influenced by mitochondrial metabolism, and present what is known about the role for mitochondrial metabolism in lung diseases marked by neutrophilic inflammation.
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Affiliation(s)
- Mary E. Maldarelli
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J. Noto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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El Omri H, Padmanabhan R, Taha RY, Kassem N, Elsabah H, Ellahie AY, Santimano AJJ, Al-Maslamani MA, Omrani AS, Elomri A, El Omri A. Dissecting bloodstream infections in febrile neutropenic patients with hematological malignancies, a decade-long single center retrospective observational study (2009-2019). J Infect Public Health 2024; 17:152-162. [PMID: 38029491 DOI: 10.1016/j.jiph.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The use of ill-suited antibiotics is a significant risk factor behind the increase in the mortality, morbidity, and economic burden for patients who are under treatment for hematological malignancy (HM) and bloodstream infections (BSI). Such unfitting treatment choices intensify the evolution of resistant variants which is a public health concern due to possible healthcare-associated infection spread to the general population. Hence, this study aims to evaluate antibiograms of patients with BSI and risk factors associated with septicemia. METHODS A total of 1166 febrile neutropenia episodes (FNE) among 513 patients with HM from the National Center for Cancer Care and Research (NCCCR), Qatar, during 2009-2019 were used for this study. The socio-demographic, clinical, microbial, and anti-microbial data retrieved from the patient's health records were used. RESULTS We analyzed the sensitivity of gram-negative and gram-positive bacilli reported in HM-FN-BSI patients. Out of the total 512 microorganisms isolated, 416 (81%) were gram-negative bacteria (GNB), 76 (15%) were gram-positive bacteria (GPB) and 20 (4%) were fungi. Furthermore, in 416 GNB, 298 (71.6%) were Enterobacteriaceae sp. among which 121 (41%) were ESBL (Extended Spectrum Beta-Lactamase) resistant to Cephalosporine third generation and Piperacillin-Tazobactam, 54 (18%) were Carbapenem-resistant or multidrug-resistant organism (MDRO). It's noteworthy that the predominant infectious agents in our hospital include E. coli, Klebsiella species, and P. aeruginosa. Throughout the study period, the mortality rate due to BSI was 23%. Risk factors that show a significant correlation with death are age, disease status, mono or polymicrobial BSI and septic shock. CONCLUSION Decision pertaining to the usage of antimicrobials for HM-FN-BSI patients is a critical task that relies on the latest pattern of prevalence, treatment resistance, and clinical outcomes. Analysis of the antibiogram of HM-FN-BSI patients in Qatar calls for a reconsideration of currently followed empirical antibiotic therapy towards better infection control and antimicrobial stewardship.
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Affiliation(s)
- Halima El Omri
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Regina Padmanabhan
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Ruba Y Taha
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Nancy Kassem
- Pharmacy Department NCCCR, Hamad Medical Corporation, Doha, Qatar
| | - Hesham Elsabah
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Anil Yousaf Ellahie
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha 3050, Qatar
| | - Antonio J J Santimano
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Ali S Omrani
- Communicable Disease Center, Hamad Medical Corporation, Qatar
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar.
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9
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Cai L, Chen H, Wei Y, Guo X, Zheng H, Jiang X, Zhang Y, Yu G, Dai M, Ye J, Zhou H, Xu D, Huang F, Fan Z, Xu N, Shi P, Xuan L, Feng R, Liu X, Sun J, Liu Q, Wei X. Changing epidemiology, microbiology and mortality of bloodstream infections in patients with haematological malignancies before and during SARS-CoV-2 pandemic: a retrospective cohort study. BMJ Open 2023; 13:e078510. [PMID: 38159939 PMCID: PMC10759088 DOI: 10.1136/bmjopen-2023-078510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE This study was to explore the changes in bacterial bloodstream infection (BSI) in patients with haematological malignancies (HMs) before and during SARS-CoV-2 pandemic. DESIGN Retrospective cohort study between 2018 and 2021. SETTING The largest haematological centre in southern China. RESULTS A total of 599 episodes of BSI occurring in 22 717 inpatients from January 2018 to December 2021 were analysed. The frequencies of the total, Gram-negative and Gram-positive BSI before and during the pandemic were 2.90% versus 2.35% (p=0.011), 2.49% versus 1.77% (p<0.001) and 0.27% versus 0.44% (p=0.027), respectively. The main isolates from Gram-negative or Gram-positive BSI and susceptibility profiles also changed. The 30-day mortality caused by BSI was lower during the pandemic (21.1% vs 14.3%, p=0.043). Multivariate analysis revealed that disease status, pulmonary infection and shock were independent predictors of 30-day mortality. CONCLUSION Our data showed that the incidence of total and Gram-negative organisms BSI decreased, but Gram-positive BSI incidence increased in patients with HMs during the pandemic along with the changes of main isolates and susceptibility profiles. Although the 30-day mortality due to BSI was lower during the pandemic, the new infection prevention strategy should be considered for any future pandemics.
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Affiliation(s)
- Linjing Cai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Huan Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Yongqiang Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xutao Guo
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Haiqing Zheng
- Nosocomial Infection Management, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuejie Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Min Dai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Hongsheng Zhou
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Dan Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Zhiping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Pengcheng Shi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Ru Feng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xiaoli Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
| | - Xiaolei Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, Clinical Medical Research Center of Hematological Diseases of Guangdong Province, Guangzhou, China
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10
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Peri AM, Edwards F, Henden A, Harris PNA, Chatfield MD, Paterson DL, Laupland KB. Bloodstream infections in neutropenic and non-neutropenic patients with haematological malignancies: epidemiological trends and clinical outcomes in Queensland, Australia over the last 20 years. Clin Exp Med 2023; 23:4563-4573. [PMID: 37815735 PMCID: PMC10725384 DOI: 10.1007/s10238-023-01206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Knowledge of the epidemiology of bloodstream infection (BSI) in haematology patients is essential to guide patient management. We investigated the epidemiology of BSI in patients with haematological malignancies in Queensland over the last 20 years (2000-2019), including all episodes diagnosed by the state-wide microbiology service. We identified 7749 BSI in 5159 patients, 58% associated with neutropenia. Gram-negatives were the main causative pathogens (58.3%), more frequent in neutropenic than non-neutropenic patients (3308/5309, 62.3% vs 1932/3678, 52.5%, p < 0.001). Amongst 8987 isolates the most common were E. coli (15.4%) and Pseudomonas spp. (14.2%). Pseudomonas spp. (16.6% vs 10.7%, p < 0.001), Klebsiella spp. (11.6% vs 6.8%, p < 0.001), viridans-group streptococci (4.4% vs 1.2%, p < 0.001) and E. faecium (2.4% vs 0.9%, p < 0.001) were more common in neutropenic than non-neutropenic patients, while S. aureus was less common (5.9% vs 15.6%, p < 0.001). Several antimicrobial resistance rates increased over time and had higher prevalence in neutropenic than non-neutropenic patients, including ciprofloxacin-resistant E. coli (94/758, 12.4% vs 42/506, 8.3%, p = 0.021), trimethoprim-sulfamethoxazole-resistant E. coli (366/764, 47.9% vs 191/517, 36.9%, p < 0.001), penicillin-resistant streptococci (51/236, 21.6% vs 28/260, 10.8%, p < 0.001) and vancomycin-resistant enterococci (46/250, 18.4% vs 9/144, 6.3%, p < 0.001). Carbapenem-resistant Pseudomonas spp. (OR 7.32, 95%CI 2.78-19.32) and fungi, including yeasts and moulds (OR 3.33, 95%CI 2.02-5.48) were associated to the highest odds of 30-day case-fatality at a multivariable logistic regression analysis. Neutropenia was associated with survival (OR 0.66, 95%CI 0.55-0.78). Differences were observed in the BSI epidemiology according to neutropenic status, with an overall increase of resistance over time associated to adverse outcome.
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Affiliation(s)
- Anna Maria Peri
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Andrea Henden
- Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Brisbane City, QLD, 4029, Australia
| | - Mark D Chatfield
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research (UQCCR), Building 71/918 RBWH Herston, Brisbane City, QLD, 4029, Australia
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Intensive Care Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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11
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Roshani M, Taheri M, Goodarzi A, Yosefimashouf R, Shokoohizadeh L. Evaluation of antibiotic resistance, toxin-antitoxin systems, virulence factors, biofilm-forming strength and genetic linkage of Escherichia coli strains isolated from bloodstream infections of leukemia patients. BMC Microbiol 2023; 23:327. [PMID: 37925405 PMCID: PMC10625236 DOI: 10.1186/s12866-023-03081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND One of the most common complications in patients with febrile neutropenia, lymphoma, leukemia, and multiple myeloma is a bloodstream infection (BSI). OBJECTIVE This study aimed to evaluate the antibiotic resistance patterns, virulence factors, biofilm-forming strength, and genetic linkage of Escherichia coli strains isolated from bloodstream infections (BSIs) of leukemia patients. METHODS The study conducted in Iran from June 2021 to December 2022, isolated 67 E. coli strains from leukemia patients' bloodstream infections in hospitals in two different areas. Several techniques including disk diffusion and broth microdilution were used to identify patterns of antibiotic resistance, microtiter plate assay to measure biofilm formation, and PCR to evaluate the prevalence of different genes such as virulence factors, toxin-antitoxin systems, resistance to β-lactams and fluoroquinolone antibiotics of E. coli strains. Additionally, the genetic linkage of the isolates was analyzed using the Enterobacterial Repeat Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) method. RESULTS The results showed that higher frequency of BSI caused by E. coli in man than female patients, and patients with acute leukemia had a higher frequency of BSI. Ampicillin and Amoxicillin-clavulanic acid showed the highest resistance, while Imipenem was identified as a suitable antibiotic for treating BSIs by E. coli. Multidrug-resistant (MDR) phenotypes were present in 22% of the isolates, while 53% of the isolates were ESBL-producing with the blaCTX-M gene as the most frequent β-lactamase gene. The fluoroquinolone resistance genes qnrB and qnrS were present in 50% and 28% of the isolates, respectively. More than 80% of the isolates showed the ability to form biofilms. The traT gene was more frequent than other virulence genes. The toxin-antitoxin system genes (mazF, ccdAB, and relB) showed a comparable frequency. The genetic diversity was detected in E. coli isolates. CONCLUSION Our results demonstrate that highly diverse, resistant and pathogenic E. coli clones are circulating among leukemia patients in Iranian hospitals. More attention should be paid to the treatment and management of E. coli bloodstream infections in patients with leukemia.
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Affiliation(s)
- Mahdaneh Roshani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Alireza Goodarzi
- Infectious Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rassoul Yosefimashouf
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Shokoohizadeh
- Department of Medical Laboratory Sciences, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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12
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Liu CG, Liao AJ. [Feature analysis of different neutrophil levels on the distribution of pathogens in bloodstream infection in patients with hematologic malignancy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:857-860. [PMID: 38049340 PMCID: PMC10694080 DOI: 10.3760/cma.j.issn.0253-2727.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Indexed: 12/06/2023]
Affiliation(s)
- C G Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - A J Liao
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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13
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Ferri G, Mucci M, Mattoscio D, Recchiuti A. Specialized pro-resolving lipid mediators and resolution of viral diseases. Prostaglandins Other Lipid Mediat 2023; 168:106762. [PMID: 37355222 PMCID: PMC10286561 DOI: 10.1016/j.prostaglandins.2023.106762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
The COVID-19 pandemics has made sparkly evident the importance of acute inflammation and its timely resolution to protect humans from pathogenic viruses while sparing them from collateral damages due to an uncontrolled immune response. It is clear now that resolution of inflammation is an active process regulated by endogenous specialized proresolving lipid mediators (SPM) biosynthesized from essential polyunsaturated fatty acids. Accruing evidence indicates that SPM are produced during viral infections and play key roles in controlling the magnitude and duration of the inflammatory response and in regulating adaptive immunity. Here, we reviewed biosynthesis and bioactions of SPM in virus-mediated human diseases. Harnessing SPM and their proresolutive actions can help in providing new therapeutic approaches to current and future human viral diseases by controlling infection, stimulating host immunity, and protecting from organ damage.
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Affiliation(s)
- Giulia Ferri
- Department of Medical, Oral, and Biotechnology Science (DSMOB), "G.d'Annunzio" University of Chieti - Pescara, Center for Advanced Studies and Technology (CAST), via Polacchi 13, 66100 Chieti, Italy
| | - Matteo Mucci
- Department of Medical, Oral, and Biotechnology Science (DSMOB), "G.d'Annunzio" University of Chieti - Pescara, Center for Advanced Studies and Technology (CAST), via Polacchi 13, 66100 Chieti, Italy
| | - Domenico Mattoscio
- Department of Medical, Oral, and Biotechnology Science (DSMOB), "G.d'Annunzio" University of Chieti - Pescara, Center for Advanced Studies and Technology (CAST), via Polacchi 13, 66100 Chieti, Italy.
| | - Antonio Recchiuti
- Department of Medical, Oral, and Biotechnology Science (DSMOB), "G.d'Annunzio" University of Chieti - Pescara, Center for Advanced Studies and Technology (CAST), via Polacchi 13, 66100 Chieti, Italy.
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14
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Ruiz-Camps I, Albasanz-Puig A. Short-course antibiotic treatment for Gram-negative bloodstream infection in neutropenic cancer patients: Less is more. Transpl Infect Dis 2023; 25:e14106. [PMID: 37489801 DOI: 10.1111/tid.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Isabel Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adaia Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
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15
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Erdem H, Kocoglu E, Ankarali H, El-Sokkary R, Hakamifard A, Karaali R, Kulzhanova S, El-Kholy A, Tehrani HA, Khedr R, Kaya-Kalem A, Pandak N, Cagla-Sonmezer M, Nizamuddin S, Berk-Cam H, Guner R, Elkholy JA, Llopis F, Marino A, Stebel R, Szabo BG, Belitova M, Fadel E, Yetisyigit T, Cag Y, Alkan S, Kayaaslan B, Oncu S, Ozdemir M, Yilmaz M, Isik AC, Başkol D, Sincan G, Cascio A, Ozer-Balin S, Korkmaz N, Ripon RK, Abbas S, Dumitru IM, Eser-Karlidag G, Lanzafame M, Rafey A, Raza A, Sipahi OR, Darazam IA, Elbahr U, Erdem I, Ergen P, Bilir C, Caskurlu H, Erdem A, Makek MJ, Altindis M, Lakatos B, Luca CM, Yilmaz EM, Nsutebu E, Cakmak R, Sirmatel F. Prospective analysis of febrile neutropenia patients with bacteraemia: the results of an international ID-IRI study. Int J Antimicrob Agents 2023; 62:106919. [PMID: 37423582 DOI: 10.1016/j.ijantimicag.2023.106919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Bacteraemia during the course of neutropenia is often fatal. We aimed to identify factors predicting mortality to have an insight into better clinical management. METHODS The study has a prospective, observational design using pooled data from febrile neutropenia patients with bacteraemia in 41 centres in 16 countries. Polymicrobial bacteraemias were excluded. It was performed through the Infectious Diseases-International Research Initiative platform between 17 March 2021 and June 2021. Univariate analysis followed by a multivariate binary logistic regression model was used to determine independent predictors of 30-d in-hospital mortality (sensitivity, 81.2%; specificity, 65%). RESULTS A total of 431 patients were enrolled, and 85 (19.7%) died. Haematological malignancies were detected in 361 (83.7%) patients. Escherichia coli (n = 117, 27.1%), Klebsiellae (n = 95, 22% %), Pseudomonadaceae (n = 63, 14.6%), Coagulase-negative Staphylococci (n = 57, 13.2%), Staphylococcus aureus (n = 30, 7%), and Enterococci (n = 21, 4.9%) were the common pathogens. Meropenem and piperacillin-tazobactam susceptibility, among the isolated pathogens, were only 66.1% and 53.6%, respectively. Pulse rate (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002-1.034), quick SOFA score (OR, 2.857; 95% CI, 2.120-3.851), inappropriate antimicrobial treatment (OR, 1.774; 95% CI, 1.011-3.851), Gram-negative bacteraemia (OR, 2.894; 95% CI, 1.437-5.825), bacteraemia of non-urinary origin (OR, 11.262; 95% CI, 1.368-92.720), and advancing age (OR, 1.017; 95% CI, 1.001-1.034) were independent predictors of mortality. Bacteraemia in our neutropenic patient population had distinctive characteristics. The severity of infection and the way to control it with appropriate antimicrobials, and local epidemiological data, came forward. CONCLUSIONS Local antibiotic susceptibility profiles should be integrated into therapeutic recommendations, and infection control and prevention measures should be prioritised in this era of rapidly increasing antibiotic resistance.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain; Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Türkiye.
| | - Esra Kocoglu
- Department of Microbiology and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ridvan Karaali
- Department of Infectious Diseases & Clinical Microbiology, Cerrahpaşa School of Medicine, Istanbul, Türkiye
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Hamed Azhdari Tehrani
- Department of Haematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reham Khedr
- Department of Paediatric Oncology, National Cancer Institute-Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Ayşe Kaya-Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | | | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Türkiye
| | - Summiya Nizamuddin
- Section of Microbiology, Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Hande Berk-Cam
- Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Türkiye
| | - Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Jehan Ali Elkholy
- Department of Anaesthesia, Pain Management, Cairo University Hospital, Cairo, Egypt
| | - Ferran Llopis
- Emergency Department, Bellvitge University Hospital, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | - Maya Belitova
- Medical University-Sofia, Department of Anaesthesiology and Intensive Care, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Elias Fadel
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Centre, King Hamad University Hospital, Busaiteen, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Türkiye
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Türkiye
| | - Mehmet Ozdemir
- Department of Medical Microbiology, Necmettin Erbakan University, Konya, Türkiye
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Arzu Cennet Isik
- Department of Internal Medicine, Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Dilşah Başkol
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Gulden Sincan
- Department of Haematology, School of Medicine, Ataturk University, Erzurum, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Italy
| | - Safak Ozer-Balin
- Department of Infectious Diseases and Clinical Microbiology, Firat University, School of Medicine, Elazig, Türkiye
| | - Nesibe Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yıldirim Beyazit Education and Research Hospital, Ankara, Türkiye
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Salma Abbas
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | | | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | | | - Abdur Rafey
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aun Raza
- Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Türkiye
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
| | - Ilknur Erdem
- Namık Kemal University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Tekirdağ, Türkiye
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Cemil Bilir
- Department of Oncology, Istinye University, VMMedical Park Pendik Hospital, Istanbul, Türkiye; Sakarya University Faculty of Medicine Department of Medical Oncology, Sakarya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Türkiye
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mustafa Altindis
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Türkiye
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
| | | | - Esmeray Mutlu Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Rumeysa Cakmak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, School of Medicine, Türkiye
| | - Fatma Sirmatel
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Abant Izzet Baysal University, Bolu, Türkiye
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16
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Quach JU, Diaz MJ, Huda TI, Kinskey JC, Zaman S, Desantis JE, Cios KJ, Blanck G. Bacterial Sequencing Reads in Blood Exome Files from Melanoma and Cervical Cancer Patients are Associated with Cancer Recurrence. Mol Biotechnol 2023; 65:1476-1484. [PMID: 36653589 DOI: 10.1007/s12033-023-00663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
Bacteremia poses great risk for morbidity and mortality for immunocompromised cancer patients. Although the presence of bacteria within solid tumors is gaining greater attention, few studies have analyzed species of bacteria in the blood and their effect on cancer clinical outcomes. Using the Kraken 2 taxonomic profiling tool, we classified bacteria present in blood and primary tumors of cervical cancer and melanoma cases. The Cancer Genome Atlas (TCGA) melanoma blood exome files with Pseudomonas species were found to represent a worse disease-free survival (DFS) probability, while a worse overall survival (OS) result was evidenced for both the TCGA and Moffitt Cancer Center melanoma datasets. Cervical cancer cases with reads representing the Bradyrhizobium genus and Bradyrhizobium sp. BTAi1 found in blood and tumor exome files were found to have lower DFS. Additionally, reduced DFS and OS were observed for cervical cancer cases positive for Bacteroides species including Bacteroides fragilis. This study provides novel evidence and a novel approach for indicating that bacteria in blood is associated with cancer recurrence. These findings may guide the development of more efficient prognostic and screening tools related to bacterial blood infections of melanoma and cervical cancer patients.
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Affiliation(s)
- Jessica U Quach
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA
| | - Michael J Diaz
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA
| | - Taha I Huda
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA
| | - Jacob C Kinskey
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Saif Zaman
- Department of Internal Medicine, Yale University, New Haven, CT, 06520, USA
| | - John E Desantis
- Research Computing, University of South Florida, Tampa, FL, 33620, USA
| | - Konrad J Cios
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA
| | - George Blanck
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Bd. MDC7, Tampa, FL, 33612, USA.
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
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17
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Plainvert C, Matuschek E, Dmytruk N, Gaillard M, Frigo A, Ballaa Y, Biesaga E, Kahlmeter G, Poyart C, Tazi A. Microbiological Epidemiology of Invasive Infections Due to Non-Beta-Hemolytic Streptococci, France, 2021. Microbiol Spectr 2023; 11:e0016023. [PMID: 37199642 PMCID: PMC10269528 DOI: 10.1128/spectrum.00160-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023] Open
Abstract
Non-beta-hemolytic streptococci (NBHS), also referred to as viridans streptococci, represent an underestimated cause of human invasive diseases. Their resistance to antibiotics, including beta-lactam agents, often complicate their therapeutic management. A prospective multicenter study was conducted by the French National Reference Center for Streptococci between March and April 2021 to describe the clinical and microbiological epidemiology of invasive infections due to NBHS, excluding pneumococcus. A total of 522 NBHS invasive cases were collected. Distribution among streptococcal groups was: Streptococcus anginosus (33%), Streptococcus mitis (28%), Streptococcus sanguinis (16%), Streptococcus bovis/equinus (15%), Streptococcus salivarius (8%), and Streptococcus mutans (<1%). Median age of infection was 68 years old (range <1 day to 100 years). Cases were more frequent in male patients (gender ratio M/F 2.1:1) and manifested mainly as bacteremia without focus (46%), intra-abdominal infections (18%) and endocarditis (11%). All isolates were susceptible to glycopeptides and displayed low-level inherent gentamicin resistance. All isolates of the S. bovis/equinus, S. anginosus, and S. mutans groups were susceptible to beta-lactams. Conversely, nonsusceptibility to beta-lactams was found in 31%, 28%, and 52% of S. mitis, S. salivarius, and S. sanguinis isolates, respectively. The screening for beta-lactam resistance using the recommended one unit benzylpenicillin disk screening failed to detect 21% of resistant isolates (21/99). Last, overall resistance rates to the alternative anti-streptococcal molecules clindamycin and moxifloxacin were 29% (149/522) and 1.6% (8/505), respectively. IMPORTANCE NBHS are recognized as opportunistic pathogens particularly involved in infections of the elderly and immunocompromised patients. This study underlines their importance as common causes of severe and difficult-to-treat infections such as endocarditis. Although species of the S. anginosus and S. bovis/equinus groups remain constantly susceptible to beta-lams, resistance in oral streptococci exceeds 30% and screening techniques are not fully reliable. Therefore, accurate species identification and antimicrobial susceptibility testing by MICs determination appears essential for the treatment of NBHS invasive infections, together with continued epidemiological surveillance.
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Affiliation(s)
- Céline Plainvert
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | | | - Nicolas Dmytruk
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Marine Gaillard
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Amandine Frigo
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Yassine Ballaa
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
| | - Eddy Biesaga
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
| | - Gunnar Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
- Department of Clinical Microbiology, Central Hospital, Växjö, Sweden
| | - Claire Poyart
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
- Université Paris Cité, Paris, France
| | - Asmaa Tazi
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Service de Bactériologie, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
- Université Paris Cité, Paris, France
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18
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Wang G, Zhu Y, Feng S, Wei B, Zhang Y, Wang J, Huang S, Qin S, Liu X, Chen B, Cui W. Extended-spectrum beta-lactamase-producing Enterobacteriaceae related urinary tract infection in adult cancer patients: a multicenter retrospective study, 2015-2019. BMC Infect Dis 2023; 23:129. [PMID: 36879210 PMCID: PMC9987039 DOI: 10.1186/s12879-023-08023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the prevalence and risk factors of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae related urinary tract infections (UTI) in adult cancer patients. METHODS We conducted a retrospective study of three cancer hospitals centered on Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2019. The clinical characters, risk factors and antimicrobial susceptibility of ESBL-producing Enterobacteriaceae UTI in adult cancer patients were described and analyzed. RESULTS A total of 4967 specimens of UTI were evaluated, of which 909 were positive. After excluding multiple infection bacteria, non-conforming strains, inconsistent pathological information, no drug sensitivity test or medical records, 358 episodes remained. Among them, 160 episodes belonged to ESBL-producing Enterobacteriaceae, while 198 were classified into non-ESBL group. The prevalence of ESBL UTI circled around 39.73 to 53.03% for 5 years. Subgroup analysis by tumor type revealed that 62.5% of isolates from patients with urological tumors were ESBL positive. Multivariate analysis showed that tumor metastasis (OR 3.41, 95%CI 1.84-6.30), urological cancer (OR 2.96, 95%CI 1.34-6.53), indwelling catheter (OR 2.08, 95%CI 1.22-3.55) and surgery or invasive manipulation (OR 1.98, 95%CI 1.13-3.50) were the independent risk factors. According to antimicrobial sensitivity, meropenem, imipenem and piperacillin/tazobactam were the most commonly used antibiotics for ESBL-producing Enterobacteriaceae UTI. CONCLUSIONS In view of the high prevalence, clinicians should be alert to the occurrence of ESBL UTI, especially for patients with urological cancer or metastatic tumors. Regular replacement of urinary catheters, reduction of unnecessary invasive operations and selection of appropriate antibiotics are the necessary conditions to deal with the occurrence of ESBL UTI in adult cancer patients.
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Affiliation(s)
- Guojing Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yu Zhu
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shana Feng
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Baojun Wei
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yujuan Zhang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jingzhi Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shengkai Huang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shengling Qin
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuan Liu
- Department of Clinical Laboratory, Beijing Chaoyang Sanhuan Cancer Hospital, Beijing, 100023, China
| | - Bing Chen
- Department of Clinical Laboratory, Cancer Hospital of Huanxing Chaoyang District Beijing, Beijing, 100005, China
| | - Wei Cui
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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19
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Liu J, Zhang H, Feng D, Wang J, Wang M, Shen B, Cao Y, Zhang X, Lin Q, Zhang F, Zheng Y, Xiao Z, Zhu X, Zhang L, Wang J, Pang A, Han M, Feng S, Jiang E. Development of a Risk Prediction Model of Subsequent Bloodstream Infection After Carbapenem-Resistant Enterobacteriaceae Isolated from Perianal Swabs in Hematological Patients. Infect Drug Resist 2023; 16:1297-1312. [PMID: 36910516 PMCID: PMC9999719 DOI: 10.2147/idr.s400939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose Patients with hematological diseases are at high risk of carbapenem-resistant Enterobacteriaceae (CRE) infection, and CRE-related bloodstream infection (BSI) is associated with high mortality risk. Therefore, developing a predictive risk model for subsequent BSI in hematological patients with CRE isolated from perianal swabs could be used to guide preventive strategies. Methods This was a single-center retrospective cohort study at a tertiary blood diseases hospital, including all hematological patients hospitalized from 10 October 2017 to 31 July 2021. We developed a predictive model using multivariable logistic regression and internally validated it using enhanced bootstrap resampling. Results Of 421 included patients with CRE isolated from perianal swabs, BSI due to CRE occurred in 59. According to the multivariate logistic analysis, age (OR[odds ratio]=1.04, 95% CI[confidence interval]: 1.01-1.06, P=0.004), both meropenem and imipenem minimal inhibitory concentration (MIC) of the isolate from perianal swabs>8ug/mL (OR=5.34, 95% CI: 2.63-11.5, P<0.001), gastrointestinal symptoms (OR=3.67, 95% CI: 1.82-7.58, P<0.001), valley absolute neutrophil count (109/L)>0.025 (OR=0.07, 95% CI: (0.02-0.19, P<0.001) and shaking chills at peak temperature (OR=6.94, 95% CI: (2.60-19.2, P<0.001) were independently associated with CRE BSI within 30 days and included in the prediction model. At a cut-off of prediction probability ≥ 21.5% the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 79.7%, 85.6%, 96.27% and 47.47%. The discrimination and calibration of the prediction model were good on the derivation data (C-statistics=0.8898; Brier score=0.079) and enhanced bootstrapped validation dataset (adjusted C-statistics=0.881; adjusted Brier score=0.083). The risk prediction model is freely available as a mobile application at https://liujia1992.shinyapps.io/dynnomapp/. Conclusion A prediction model based on age, meropenem and imipenem MIC of isolate, gastrointestinal symptoms, valley absolute neutrophil count and shaking chills may be used to better inform interventions in hematological patients with CRE isolated from perianal swabs.
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Affiliation(s)
- Jia Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Haixiao Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Dan Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Jiali Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Mingyang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Biao Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yigeng Cao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Xiaoyu Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Qingsong Lin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Fengkui Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Zhijian Xiao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Xiaofan Zhu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Aiming Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Mingzhe Han
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
| | - Erlie Jiang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
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20
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Better Outcome of Off-Label High-Dose Ceftazidime in Hemato-Oncological Patients with Infections Caused by Extensively Drug-Resistant Pseudomonas Aeruginosa. Mediterr J Hematol Infect Dis 2023; 15:e2023001. [PMID: 36660352 PMCID: PMC9833305 DOI: 10.4084/mjhid.2023.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/09/2022] [Indexed: 01/03/2023] Open
Abstract
Background P. aeruginosa sepsis in immunocompromised patients is a serious complication of cancer treatment, especially in the case of an Extensively Drug Resistant (XDR) pathogen. The aim of the study is to evaluate the efficacy of high-dose ceftazidime in the treatment of XDR P. aeruginosa infection and to compare it with the conventionally treated cohort in hemato-oncological patients. Methods We identified 27 patients with XDR P. aeruginosa infection during the 2008-2018 period, 16 patients served as a conventionally treated cohort with an antipseudomonal beta-lactam antibiotic in standard dose (cohort A), and 11 patients were treated with high-dose ceftazidime (cohort B). Most of the patients were neutropenic and under active treatment for their cancer in both cohorts. Results Mortality and related mortality were statistically significantly better for cohort B than cohort A; it was 18.2% and 9.1% for cohort B and 68.8% and 68.8% for cohort A, respectively. More patients in cohort A needed mechanical ventilation and renal replacement therapy, 75% and 50% for cohort A and 27.3% and 9.9% for cohort B, respectively. It corresponded well with the worst sequential organ failure score (SOFA) in cohort A compared to cohort B, 16 versus 7, respectively. Reversible neurotoxicity was seen only in two patients in cohort B. Conclusion Ceftazidime in high doses is a very potent antibiotic (ATB) for treating XDR P. aeruginosa infections in neutropenic cancer with acceptable toxicity.
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Joyce LR, Youngblom MA, Cormaty H, Gartstein E, Barber KE, Akins RL, Pepperell CS, Palmer KL. Comparative Genomics of Streptococcus oralis Identifies Large Scale Homologous Recombination and a Genetic Variant Associated with Infection. mSphere 2022; 7:e0050922. [PMID: 36321824 PMCID: PMC9769543 DOI: 10.1128/msphere.00509-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
The viridans group streptococci (VGS) are a large consortium of commensal streptococci that colonize the human body. Many species within this group are opportunistic pathogens causing bacteremia and infective endocarditis (IE), yet little is known about why some strains cause invasive disease. Identification of virulence determinants is complicated by the difficulty of distinguishing between the closely related species of this group. Here, we analyzed genomic data from VGS that were isolated from blood cultures in patients with invasive infections and oral swabs of healthy volunteers and then determined the best-performing methods for species identification. Using whole-genome sequence data, we characterized the population structure of a diverse sample of Streptococcus oralis isolates and found evidence of frequent recombination. We used multiple genome-wide association study tools to identify candidate determinants of invasiveness. These tools gave consistent results, leading to the discovery of a single synonymous single nucleotide polymorphism (SNP) that was significantly associated with invasiveness. This SNP was within a previously undescribed gene that was conserved across the majority of VGS species. Using the growth in the presence of human serum and a simulated infective endocarditis vegetation model, we were unable to identify a phenotype for the enriched allele in laboratory assays, suggesting a phenotype may be specific to natural infection. These data highlighted the power of analyzing natural populations for gaining insight into pathogenicity, particularly for organisms with complex population structures like the VGS. IMPORTANCE The viridians group streptococci (VGS) are a large collection of closely related commensal streptococci, with many being opportunistic pathogens causing invasive diseases, such as bacteremia and infective endocarditis. Little is known about virulence determinants in these species, and there is a distinct lack of genomic information available for the VGS. In this study, we collected VGS isolates from invasive infections and healthy volunteers and performed whole-genome sequencing for a suite of downstream analyses. We focused on a diverse sample of Streptococcus oralis genomes and identified high rates of recombination in the population as well as a single genome variant highly enriched in invasive isolates. The variant lies within a previously uncharacterized gene, nrdM, which shared homology with the anaerobic ribonucleoside triphosphate reductase, nrdD, and was highly conserved among VGS. This work increased our knowledge of VGS genomics and indicated that differences in virulence potential among S. oralis isolates were, at least in part, genetically determined.
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Affiliation(s)
- Luke R. Joyce
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Madison A. Youngblom
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Harshini Cormaty
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Evelyn Gartstein
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
| | - Katie E. Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, University of Mississippi, Jackson, Mississippi, USA
| | | | - Caitlin S. Pepperell
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Medicine (Infectious Diseases), School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kelli L. Palmer
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, Texas, USA
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Royo-Cebrecos C, Laporte-Amargós J, Peña M, Ruiz-Camps I, Puerta-Alcalde P, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Morales HMP, Brunel AS, García E, Isler B, Kern WV, Palacios-Baena ZR, de la Calle GM, Montero MM, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatti P, Araos R, Peghin M, del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, Carratalà J, Gudiol C. Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors. Pathogens 2022; 11:pathogens11101132. [PMID: 36297188 PMCID: PMC9610728 DOI: 10.3390/pathogens11101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006−May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.
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Affiliation(s)
- Cristina Royo-Cebrecos
- Internal Medicine Department, Hospital Nostra Senyora de Meritxell, Andorra Health Services (SAAS), AD700 Escaldes-Engordany, Andorra
| | - Julia Laporte-Amargós
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain
- Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, 08907 Barcelona, Spain
| | - Marta Peña
- Hematology Department, Institut Català d’Oncologia (ICO)–Hospital Duran i Reynals, IDIBELL, 08907 Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic i Provincial, 08035 Barcelona, Spain
| | - Edson Abdala
- Instituto do Câncer do Estado de São Paulo, Faculty of Medicine, Univesity of São Paulo, Sao Paulo 01246, Brazil
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, 48903 Bilbao, Spain
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Fabian Herrera
- Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1430EFA, Argentina
| | - Oriol Gasch
- Infectious Diseases Department, Parc Taulí University Hospital, 08208 Sabadell, Spain
| | - Lubos Drgona
- Oncohematology Department, Comenius University and National Cancer Institute, 81499 Bratislava, Slovakia
| | | | - Anne-Sophie Brunel
- Infectious Diseases Department, Department of Medicine, Lausanne University Hospital, (CHUV), 1011 Lausanne, Switzerland
| | - Estefanía García
- Hematology Department, Reina Sofía University Hospital-IMIBIC-UCO, Córdoba 14004, Argentina
| | - Burcu Isler
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, 34668 Istanbul, Turkey
| | - Winfried V. Kern
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Center and Faculty of Medicine, 79106 Freiburg, Germany
| | - Zaira R. Palacios-Baena
- Unit of Infectious Diseases and Clinical Microbiology, Virgen Macarena University Hospital, Institute of Biomedicine of Seville (IBIS), 41013 Seville, Spain
| | - Guillermo Maestro de la Calle
- Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i+12), “12 de Octubre”, University Hospital, School of Medicine, Universidad Complutense, 28041 Madrid, Spain
| | - Maria Milagro Montero
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain
| | - Souha S. Kanj
- Infectious Diseases Division, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Oguz R. Sipahi
- Faculty of Medicine, Ege University, 35040 Izmir, Turkey
| | - Sebnem Calik
- University of Health Science Izmir Bozyaka Training and Research Hospital, 35170 Izmir, Turkey
| | | | - Jorge I. Marin
- Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Pereira, Colombia. Critical Care and Clinical Microbiology Department, Manizales 170001-17, Colombia
| | - Marisa Z. R. Gomes
- Hospital Federal dos Servidores do Estado, and Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro 20221-161, Brazil
| | - Philipp Hemmatti
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital, Charité University Medical School, 10117 Berlin, Germany
| | - Rafael Araos
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago de Chile 12461, Chile, and Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R)
| | - Maddalena Peghin
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata in Udine, and Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 33100 Udine, Italy
| | - José Luis del Pozo
- Infectious Diseases and Microbiology Unit, Navarra University Clinic, 31008 Pamplona, Spain
| | - Lucrecia Yáñez
- Hematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
| | - Robert Tilley
- Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK
| | - Adriana Manzur
- Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina
| | - Andrés Novo
- Hematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain
- University of Barcelona, 08007 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 Barcelona, Spain
- Institut Català d’Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, 08907 Barcelona, Spain
- University of Barcelona, 08007 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-932607625; Fax: +34-932607637
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Guimarães T, Borges IC, Spadão FDS, Mariano L, Nascimento MDM, Higashino H, Rossi F, Rocha V, Costa SF. Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients. Antibiotics (Basel) 2022; 11:antibiotics11091269. [PMID: 36140048 PMCID: PMC9495722 DOI: 10.3390/antibiotics11091269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016–2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited.
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Affiliation(s)
- Thaís Guimarães
- Department of Infection Control, Instituto Central, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Igor Carmo Borges
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Fernanda de Souza Spadão
- Department of Infection Control, Instituto Central, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Livia Mariano
- Hematology Department, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | | | - Hermes Higashino
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Flavia Rossi
- Microbiology Laboratory, Central Laboratory Division, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Vanderson Rocha
- Hematology Department, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
| | - Silvia Figueiredo Costa
- Infectious Diseases Department, Hospital das Clínicas, University of São Paulo, São Paulo 05508-220, Brazil
- Correspondence: ; Tel.: +55-11-3061-7011
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Shi N, Kang J, Wang S, Song Y, Yin D, Li X, Guo Q, Duan J, Zhang S. Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China. Infect Drug Resist 2022; 15:3561-3578. [PMID: 35833010 PMCID: PMC9271686 DOI: 10.2147/idr.s370326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to analyze the epidemiological of gram-negative bloodstream infection (GNBSI) and establish a risk prediction model for mortality and acquiring multidrug resistant (MDR), the extended spectrum beta-lactamases (ESBLs) producing and carbapenem-resistant (CR) GNBSI. Methods This retrospective study covered five years from January 2015 to December 2019. Data were obtained from Hospital Information System (HIS) and microbiology department records. The risk factors for mortality and acquiring MDR, ESBLs-producing and CR GNBSI were analyzed by univariable and multivariable analysis. Results A total of 1018 GNBSI cases were collected. A majority of GNBSI patients were in hematology ward (23.77%). There were 38.61% patients who were assigned in the 41–60 age group. Escherichia coli was the most common gram-negative organism (49.90%). Among isolates of GNBSI, 40.47% were found to be MDR strains, 34.09% were found to be ESBLs-producing strains and 7.06% were found to be CR strains. Escherichia coli was the most common MDR (71.36%) and ESBLs-producing strain (77.81%). Acinetobacter baumannii was the most common CR isolate (46.15%). Multivariate analysis indicated that diabetes mellitus, solid organ tumor, non-fermentative bacteria, MDR strain, central venous cannula, urinary catheter, therapy with carbapenems or tigecycline prior 30 days of infection were independent mortality risk factors for GNBSIs. Over all, therapy with tigecycline prior 30 days of infection was the mutual predictor for mortality of GNBSI, acquiring MDR, ESBLs-producing and CR GNBSI (OR, 8.221, OR, 3.963, OR, 3.588, OR, 9.222, respectively, all p < 0.001). Conclusion Collectively, our study implies that patients who were diagnosed as GNBSI had a younger age. Therapy with tigecycline was the mutual and paramount predictor for mortality of GNBSI, acquiring MDR, ESBLs-producing and CR GNBSI. Our investigation had provided a theoretical basis for the use of antibiotics and prevention and control of hospital infection in our region.
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Affiliation(s)
- Nan Shi
- Department of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jianbang Kang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Shuyun Wang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Yan Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Donghong Yin
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Xiaoxia Li
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Qian Guo
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jinju Duan
- Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
- Correspondence: Jinju Duan; Shuqiu Zhang, Email ; ;
| | - Shuqiu Zhang
- Department of Pharmacy, Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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Kim JH, Kim TS, Chang E, Kang CK, Choe PG, Kim NJ, Oh MD, Park WB, Kim I. Effectiveness of antimicrobial stewardship programmes based on rapid antibiotic susceptibility testing of haematologic patients having high-risk factors for bacteraemia related mortality: A post-hoc analysis of an RCT. Int J Antimicrob Agents 2022; 60:106604. [PMID: 35588970 DOI: 10.1016/j.ijantimicag.2022.106604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A randomised controlled trial showed that rapid phenotypic antibiotic susceptibility testing (AST) with antimicrobial stewardship programmes (ASP) increases the proportion of haematologic patients with bacteraemia receiving optimal targeted therapy within 72 hrs of blood culture collection. The present post-hoc analysis aimed to evaluate the effects of rapid phenotypic AST intervention in haematologic patients at high risk of a poor outcome from bacteraemia. METHODS Haematologic patients with bacteraemia (n = 116) were assigned randomly to a conventional AST group or a rapid AST group. The two outcome measures were the proportion of patients receiving optimal targeted therapy at 72 hrs post-blood culture collection and the time to optimal targeted therapy; subgroup analysis was conducted based on baseline demographics (age, sex) and prognostic (Charlson comorbidity index, haematologic treatment intensity, Pitt bacteraemia score, appropriateness of empirical antibiotic therapy and multidrug-resistant organism) indicators. The interaction effect between the intervention and subgroup factors was examined using regression model analysis. RESULTS Age, sex, Charlson comorbidity index, haematologic treatment intensity, Pitt bacteraemia score and appropriateness of empirical antibiotic therapy had no significant interaction effects on the proportion of patients receiving optimal targeted therapy (P = 0.129-0.826). However, infection by a multidrug-resistant organism did have a significant interaction effect (P = 0.042). Regarding time to optimal targeted therapy, there were no significant interaction effects between the intervention and subgroup factors (P = 0.156-0.848). CONCLUSIONS Rapid phenotypic AST intervention may accelerate early optimal targeted antimicrobial treatment of haematologic patients, even those in high-risk subgroups with bacteraemia.
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Affiliation(s)
- Jeong-Han Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euijin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
| | - Inho Kim
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
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Basu A, Singh R, Gupta S. Bacterial infections in cancer: A bilateral relationship. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1771. [PMID: 34994112 DOI: 10.1002/wnan.1771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/09/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
Bacteria share a long commensal relationship with the human body. New findings, however, continue to unravel many complexities associated with this old alliance. In the past decades, the dysbiosis of human microbiome has been linked to tumorigenesis, and more recently to spontaneous colonization of existing tumors. The topic, however, remains open for debate as the claims for causative-prevailing dual characteristics of bacteria are mostly based on epidemiological evidence rather than robust mechanistic models. There are also no reviews linking the collective impact of bacteria in tumor microenvironments to the efficacy of cancer drugs, mechanisms of pathogen-initiated cancer and bacterial colonization, personalized nanomedicine, nanotechnology, and antimicrobial resistance. In this review, we provide a holistic overview of the bilateral relationship between cancer and bacteria covering all these aspects. Our collated evidence from the literature does not merely categorize bacteria as cancer causative or prevailing agents, but also critically highlights the gaps in the literature where more detailed studies may be required to reach such a conclusion. Arguments are made in favor of dual drug therapies that can simultaneously co-target bacteria and cancer cells to overcome drug resistance. Also discussed are the opportunities for leveraging the natural colonization and remission power of bacteria for cancer treatment. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Infectious Disease Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Therapeutic Approaches and Drug Discovery > Emerging Technologies.
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Affiliation(s)
- Abhirup Basu
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Rohini Singh
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Shalini Gupta
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
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Real-Life Use of Ceftolozane/Tazobactam for the Treatment of Bloodstream Infection Due to Pseudomonas aeruginosa in Neutropenic Hematologic Patients: a Matched Control Study (ZENITH Study). Microbiol Spectr 2022; 10:e0229221. [PMID: 35475683 PMCID: PMC9241913 DOI: 10.1128/spectrum.02292-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T.
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Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
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Naji A, SarKo S, Atta S. Current Sites of Infections and Types of Microorganisms in Patient with Febrile Neutropenia in Hematological Wards – Single Center Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Febrile neutropenia occurs in more than 80% of patients with hematological malignances specially after chemotherapy cycles and an infectious source is identified in approximately 20–30%. Various bacterial, viral, and fungal pathogen contribute to the development of neutropenic fever and without prompt antibiotic therapy mortality rate can be as high as 70%.
AIM: The objective of the study was to document the current sites of infection in patients with febrile neutropenia in hematological ward in Baghdad Teaching Hospital, the microorganisms and antibiotic susceptibly in culture positive cases and mortality rate in 1 week and 4 weeks after episode of fever.
PATIENTS AND METHODS: One hundred cases of febrile neutropenia were evaluated in Hematological Ward of Baghdad Teaching Hospital from January 2019 to January 2020. Detailed history, physical examination, and laboratory investigations were conducted and statistical analysis of the results was done.
RESULTS: One hundred cases of febrile neutropenia, mean age of presentation was 41.56 ± 10.5 years. Acute myeloid leukemia (36%) and acute lymphocytic leukemia (26%) were the most common underlying hematological disorder, followed by Aplastic Anemia, Non-Hodgkin Lymphoma, and Hodgkin Lymphoma. Temperature ranged from 38°C to 39°C with mean temperature of 38.4°C and most of the patient presented with short duration of fever, 57% had absolute neutrophil count below 150 cells/μL with mean duration of neutropenia was 14.01 days. Respiratory tract was the most common site of infection (52%) followed by urinary tract (18%) and in 16% had no obvious focus of infection. Thirty percent of cases were culture Gram-positive and Gram-negative microorganism which were more common 62.9% which were generally sensitive to Aminoglycosides while Gram-positive microorganism constituted 29.6% of isolated bacteria and were generally sensitive to vancomycin. No mortality documented 1 and 4 weeks after fever.
CONCLUSION: We concluded that the most frequent sites of infection in patient with febrile neutropenia were respiratory tract followed by urinary tract infection, while 16% had undetermined source of infection. Thirty percent of patients had a positive blood culture with Escherichia coli being the most common infecting microorganism, Gram-negative microorganisms were more common than Gram-positive microorganism and fungal infection constituted about 6% of growth. Significant association was found between the fever and longer duration of neutropenia and the greater severity of neutropenia was observed. No mortality related to febrile neutropenia was documented.
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Torres I, Huntley D, Tormo M, Calabuig M, Hernández-Boluda JC, Terol MJ, Carretero C, de Michelena P, Pérez A, Piñana JL, Colomina J, Solano C, Navarro D. Multi-body-site colonization screening cultures for predicting multi-drug resistant Gram-negative and Gram-positive bacteremia in hematological patients. BMC Infect Dis 2022; 22:172. [PMID: 35189833 PMCID: PMC8862203 DOI: 10.1186/s12879-022-07154-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/12/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate the multi-drug resistant bacteria (MDRB) colonization rate in hematological patients hospitalized for any cause using a multi-body-site surveillance approach, and determine the extent to which this screening strategy helped anticipate MDRB bloodstream infections (BSI). METHODS Single-center retrospective observational study including 361 admissions documented in 250 adult patients. Surveillance cultures of nasal, pharyngeal, axillary and rectal specimens (the latter two combined) were performed at admission and subsequently on a weekly basis. Blood culture samples were incubated in an automated continuous monitoring blood culturing instrument (BACTEC FX). RESULTS In total, 3463 surveillance cultures were performed (pharyngeal, n = 1201; axillary-rectal, n = 1200; nasal, n = 1062). MDRB colonization was documented in 122 out of 361 (33.7%) admissions corresponding to 86 patients (34.4%). A total of 149 MDRB were isolated from one or more body sites, of which most were Gram-negative bacteria, most frequently non-fermenting (n = 83) followed by Enterobacterales (n = 51). BSI were documented in 102 admissions (28%) involving 87 patients. Overall, the rate of BSI caused by MDRB was significantly higher (p = 0.04) in the presence of colonizing MDRB (16 out of 47 admissions in 14 patients) than in its absence (9 out of 55 admissions in 9 patients). Colonization by any MDRB was independently associated with increased risk of MDRB-BSI (HR, 3.70; 95% CI, 1.38-9.90; p = 0.009). CONCLUSION MDRB colonization is a frequent event in hematological patients hospitalized for any reason and is associated with an increased risk of MDRB BSI. The data lend support to the use of MDRB colonization surveillance cultures for predicting the occurrence of MDRB BSI in this cohort.
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Affiliation(s)
- Ignacio Torres
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Dixie Huntley
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Mar Tormo
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Marisa Calabuig
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | | | - María José Terol
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Paula de Michelena
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - José Luis Piñana
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Javier Colomina
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
| | - Carlos Solano
- Hematology Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain. .,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain. .,Department of Microbiology, School of Medicine, University of Valencia, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.
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Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology-Oncology Unit: A 10-Year Study. J Clin Med 2022; 11:jcm11030880. [PMID: 35160334 PMCID: PMC8836920 DOI: 10.3390/jcm11030880] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 12/21/2022] Open
Abstract
Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected and analyzed. Monomicrobial Gram-positive (GP), Gram-negative (GN), and fungal BSIs accounted for 50% (77/154), 38.3% (59/144), and 3.2% (5/154) of all episodes. Polymicrobial infections were 7.8% (12/154), while mixed bacterial-fungal infections were 0.6% (1/154). The most frequent GN isolates were Escherichia coli (46.9%), followed by Pseudomonas aeruginosa (21.9%), Klebsiella species (18.8%), and Enterobacter species (6.3%). Overall, 18.8% (12/64) of GN organisms were multidrug-resistant (seven Escherichia coli, three Klebsiella pneumoniae, and two Enterobacter cloacae), whereas GP resistance to glycopeptides was observed in 1% (1/97). Initial empirical antibiotic therapy was deemed inappropriate in 12.3% of BSIs (19/154). The 30-day mortality was 7.1% (11/154), while the bacteremia-attributable mortality was 3.9% (6/154). In multivariate analysis, septic shock was significantly associated with 30-day mortality (p = 0.0001). Attentive analysis of epidemiology and continuous microbiological surveillance are essential for the appropriate treatment of bacterial infections in pediatric onco-hematological patients.
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Rolston KVI, Gerges BZ, Reitzel R, Shelburne SS, Aitken SL, Raad II, Prince RA. In vitro activity of imipenem/relebactam and comparator agents against clinical bacterial isolates from patients with cancer. J Glob Antimicrob Resist 2022; 29:1-6. [PMID: 35121163 DOI: 10.1016/j.jgar.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/05/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Gram-negative bacilli (GNB) are currently the predominant bacterial pathogens in patients with cancer. Many GNB have become problematic due to the widespread emergence of resistance. Imipenem/relebactam (IMP/REL) is a combination of the carbapenem imipenem with relebactam, a non-beta-lactam beta-lactamase inhibitor. It is active against most pathogenic GNB including many that are resistant to other agents. We compared its in vitro activity to 6 other agents against 490 GNB recovered exclusively from patients with cancer, since such data are scarce. METHODS CLSI microbroth dilution methods were used for susceptibility testing. Whole genome sequencing (Illumina MiSeq) was performed on 30 selected isolates. RESULTS IMP/REL was active against 98 % of Enterobacterales and 87 % of non-Enterobacterales isolates (excluding Stenotrophomonas maltophilia). It had potent activity against ESBL-producing Escherichia coli and Klebsiella pneumoniae, and other Enterobacterales (Enterobacter cloacae, Citrobacter spp., and Serratia spp.), and moderate activity against carbapenem-resistant Enterobacterales. IMI/REL had potent activity against Achromobacter spp., non-MDR Pseudomonas aeruginosa, and Sphingomonas paucimobilis and moderate activity against MDR P. aeruginosa. Overall, imipenem/relebactam was associated with the lowest number of non-susceptible isolates compared to 6 other agents (imipenem, meropenem, cefepime, piperacillin/tazobactam, amikacin, and tigecycline) commonly used in cancer patients. Whole genome sequencing performed on 30 resistant isolates (10 each of E. coli, Klebsiella pneumonia, and P.aeruginosa) did not reveal any predominant mechanism of resistance to imipenem/relebactam. CONCLUSION Its in vitro activity indicates that IMI/REL might have a role to play for the treatment of Gram-negative infections in patients with cancer.
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Affiliation(s)
| | - Bahgat Z Gerges
- Department of Infectious Diseases, Infection Control and Employee Health
| | - Ruth Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health
| | - Samuel S Shelburne
- Department of Infectious Diseases, Infection Control and Employee Health
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas M D Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health
| | - Randall A Prince
- Department of Infectious Diseases, Infection Control and Employee Health
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Abstract
BACKGROUND Sepsis is a leading cause of mortality in patients with neutropenia; however, data on whether neutropenic sepsis is associated with distinct clinical characteristics and outcomes are limited. Thus, this study was designed to clarify the clinical characteristics and outcomes of patients with neutropenic sepsis compared with those of patients without neutropenic sepsis diagnosed based on the Third International Consensus Definitions for Sepsis and Septic Shock criteria. METHODS We analyzed data from the Korean Sepsis Alliance, a nationwide prospective multicenter cohort study evaluating the clinical characteristics, management, and outcomes of patients with sepsis from September 2019 to February 2020. Eligible patients were divided into the neutropenic (absolute neutrophil count of less than 1,500/mL) and non-neutropenic groups. The characteristics and outcomes were compared between the two groups. RESULTS During the study period, 2,074 patients were enrolled from 16 tertiary referral or university-affiliated hospitals. Of them, 218 (10.5%) had neutropenia. The neutropenia group was younger and had a lower proportion of patients with chronic diseases compared to the non-neutropenia group. However, solid tumors (50.0% vs. 34.1%; P > 0.001) and hematological malignancies (40.8% vs. 3.8%; P < 0.001) were more common in the neutropenia group. The neutropenia group had a higher incidence of septic shock (43.6% vs. 22.9%; P < 0.001) and higher Sequential Organ Failure Assessment score (7 vs. 5; P < 0.001) than the non-neutropenia group. However, no significant differences in microbiologically confirmed infections and its pathogen distribution and the incidence of multidrug resistance were observed between the two groups. The neutropenic group had a higher hospital mortality than the non-neutropenic group (42.2% vs. 26.3%; P < 0.001), and the Kaplan-Meier survival curve demonstrated a significant difference in survival within 1 week after diagnosing sepsis (log-rank test, P = 0.002). The incidence of adverse events during intensive care unit admission was not different between the two groups. Among hospital survivors, the neutropenic group was more frequently discharged to home (72.2% vs. 57.8%; P = 0.002). CONCLUSIONS Neutropenic sepsis is associated with a higher-grade organ dysfunction during the diagnosis of sepsis and higher mortality without difference in the pathogen isolated.
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Keck JM, Wingler MJB, Cretella DA, Vijayvargiya P, Wagner JL, Barber KE, Jhaveri TA, Stover KR. Approach to fever in patients with neutropenia: a review of diagnosis and management. Ther Adv Infect Dis 2022; 9:20499361221138346. [DOI: 10.1177/20499361221138346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022] Open
Abstract
Febrile neutropenia (FN) is associated with mortality rates as high as 40%, highlighting the importance of appropriate clinical management in this patient population. The morbidity and mortality of FN can be attributed largely to infectious processes, with specific concern for infections caused by pathogens with antimicrobial resistance. Expeditious identification of responsible pathogens and subsequent initiation of empiric antimicrobial therapy is imperative. There are four commonly used guidelines, which have variable recommendations for empiric therapy in these populations. All agree that changes could be made once patients are stable and/or with an absolute neutrophil count (ANC) over 500 cells/mcL. Diagnostic advances have the potential to improve knowledge of pathogens responsible for FN and decrease time to results. In addition, more recent data show that rapid de-escalation or discontinuation of empiric therapy, regardless of ANC, may reduce days of therapy, adverse effects, and cost, without affecting clinical outcomes. Antimicrobial and diagnostic stewardship should be performed to identify, utilize, and respond to appropriate rapid diagnostic tests that will aid in the definitive management of this population.
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Affiliation(s)
- J. Myles Keck
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | - Jamie L. Wagner
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | - Katie E. Barber
- University of Mississippi School of Pharmacy, Jackson, MS, USA
| | | | - Kayla R. Stover
- School of Pharmacy, University of Mississippi, 2500 N State Street, Jackson, MS 39216, USA
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Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections. Curr Opin Infect Dis 2021; 34:686-692. [PMID: 34310454 DOI: 10.1097/qco.0000000000000768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%. RECENT FINDINGS It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are among the most vulnerable for the worst outcomes. Environmental exposure, integrity of the microbiota, and host immunity are the key determinants for the initial colonization and expansion on mucosal surfaces and potential invasion afterwards by MDR P. aeruginosa. SUMMARY Available data suggest that high colonization pressure (settings with high prevalence like intensive care units), disruption of healthy microbiota (prior use of antibiotics, in particular fluoroquinolones), immunosuppression (neutropenia) and breaking natural barriers (venous or urine catheters), are the main risk factors for MDR P. aeruginosa BSI.
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RODRIGUES I, NASCIMENTO L, PIMENTA AC, RAIMUNDO S, CONDE B, FERNANDES A. [Neutropenic Fever in Lung Cancer: Clinical Aspects Related to Mortality and Antibiotic Failure]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:764-769. [PMID: 34802207 PMCID: PMC8607283 DOI: 10.3779/j.issn.1009-3419.2021.102.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lung cancer (LC) is the leading cause of cancer death. Patients treated with chemotherapy are at risk of developing chemotherapy-induced febrile neutropenia (FN), a potentially life-threatening complication. The aims of this study were (1) to characterize FN admissions of patients with LC in a pulmonology department, and (2) to determine associations between patient profiles, first-line antibiotic failure (FLAF) and mortality. METHODS Retrospective observational case-series, based on the analysis of medical records of LC patients that required hospitalization due to chemotherapy-induced FN. RESULTS A total of 42 cases of FN were revised, corresponding to 36 patients, of which 86.1% were male, with a mean age of 66.71±9.83 years. Most patients had a performance status (PS) equal or less than 1, and metastatic disease was present in 40.5% (n=17). Respiratory tract infections accounted for 42.9% (n=18) of FN cases, and multidrug-resistant Staphylococcus aureus was the most isolated agent. The mortality rate was 16.7% (n=7), and the FLAF was 26.2% (n=11). Mortality was associated with a PS≥2 (P=0.011), infection by a Gram-negative agent (P=0.001) and severe anemia (P=0.048). FLAF was associated with longer hospitalizations (P=0.020), PS≥2 (P=0.049), respiratory infections (P=0.024), and infection by a Gram-negative (P=0.003) or multidrug-resistant agent (P=0.014). CONCLUSIONS Lower PS, severe anemia, and infections by Gram-negative or multi-resistant agents seem to be associated with worse outcomes in FN patients.
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Affiliation(s)
- Inês RODRIGUES
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal,Inês RODRIGUES, E-mail:
| | - Luísa NASCIMENTO
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Ana Cláudia PIMENTA
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Sara RAIMUNDO
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Bebiana CONDE
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Ana FERNANDES
- Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Lee DH, Patel RH, Mehra I, Shenoy R, Nanjappa S, Greene J. A Case Series of Elizabethkingia meningosepticum Bacteremia in the Cancer Population. Cureus 2021; 13:e18627. [PMID: 34786228 PMCID: PMC8580113 DOI: 10.7759/cureus.18627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/09/2021] [Indexed: 11/11/2022] Open
Abstract
Elizabethkingia meningosepticum (E.meningosepticum) is a ubiquitous microorganism previously known as Chryseobacterium meningosepticum. It is emerging as a pathogen responsible for bacteremia in the immunocompromised population, particularly in cancer patients and those with a history of prolonged hospital stay and frequent instrumentations. A retrospective chart review of all cases over 10 years at the Moffitt Cancer Center showed a total of three patients with E.meningosepticum infection. The first patient (history of multiple myeloma) underwent endoscopy complicated by aspiration pneumonia and positive blood culture for E.meningosepticum infection. The second patient (current acute myelogenous leukemia) had neutropenic fever in the setting of a recent chest port infection. Blood culture from the chest port showed E. meningosepticum. The third patient (history of esophageal adenocarcinoma and acute myelogenous leukemia) had a history of recent pneumonia and cellulitis who presented with recurrent neutropenic fever. Blood culture was positive for E. meningosepticum. E.meningosepticum bacteremia has a high 28-day mortality rate (41%). As these three cases illustrate, early identification of the pathogen along with empiric treatment with a fluoroquinolone and/or minocycline is indicated to reduce morbidity and mortality.
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Affiliation(s)
- Dae Hyun Lee
- Cardiology, University of South Florida, Tampa, USA
| | - Raj H Patel
- Internal Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Ishita Mehra
- Internal Medicine, North Alabama Medical Center, Florence, USA
| | - Rahul Shenoy
- Internal Medicine, Case Western Reserve University, Cleveland, USA
| | | | - John Greene
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
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Facchin G, Candoni A, Lazzarotto D, Zannier ME, Peghin M, Sozio E, Pellegrini N, Filì C, Sartor A, Tascini C, Fanin R. Clinical characteristics and outcome of 125 polymicrobial bloodstream infections in hematological patients: an 11-year epidemiologic survey. Support Care Cancer 2021; 30:2359-2366. [PMID: 34741656 DOI: 10.1007/s00520-021-06640-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Polymicrobial bloodstream infections (pBSI) occurring in hematological patients are still poorly understood, and specific information are very limited. OBJECTIVES AND METHODS In this epidemiologic survey, we describe clinical characteristics and outcome of 125 consecutive pBSI occurred in oncohematological patients. Polymicrobial bloodstream infections (pBSI) were defined with the isolation of 2 or more bacteria from blood culture specimens obtained within 72 h. RESULTS Over an 11-year period, we documented 500 bacterial bloodstream infections (BSI) in 4542 hospital admissions and 25% (125) of these were pBSI. Most common underlying hematological disease was acute myeloid leukemia and 89% of patients had severe neutropenia. Fifty pBSI (40%) occurred in patients undergoing a stem cell transplantation (SCT), mostly within 30 days from transplant (42/50-84%). Principal bacterial association was Gram-positive plus Gram-negative (57%). Resolution rate of pBSI was 82%, without differences between SCT and non-SCT cases. pBSI-related mortality was 15% (6% in SCT cases). Septic shock occurred in 16% of cases and septic shock-related mortality was 65% (75% in SCT cases and 63% in non-SCT cases; p = 0.6). Multidrug-resistant (MDR) bacteria were involved in 22% of pBSI and the MDR-pBSI-related mortality was significantly higher in SCT patients (p = 0.007). CONCLUSIONS This observational study highlights that pBSI is not a rare bloodstream infectious complication in oncohematological patients. pBSI-related mortality is lower than 20%, but, if septic shock occurs, mortality reaches 65%. MDR bacteria were involved in 22% of cases and pBSI-MDR-related mortality was significantly higher in SCT patients.
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Affiliation(s)
- Gabriele Facchin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy.
| | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Davide Lazzarotto
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Maria Elena Zannier
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Maddalena Peghin
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Emanuela Sozio
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Nicolò Pellegrini
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Carla Filì
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
| | - Assunta Sartor
- Clinical Microbiology, University Hospital ASUFC, Udine, Italy
| | - Carlo Tascini
- Division of Infectious Diseases, University Hospital ASUFC, Udine, Italy
| | - Renato Fanin
- Division of Hematology and Stem Cell Transplantation, University Hospital ASUFC, Udine, Italy
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Amoah J, Klein EY, Chiotos K, Cosgrove SE, Tamma PD. Administration of a β-lactam Prior to Vancomycin as the First Dose of Antibiotic Therapy Improves Survival in Patients with Bloodstream Infections. Clin Infect Dis 2021; 75:98-104. [PMID: 34606585 DOI: 10.1093/cid/ciab865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Prompt initiation of antibiotic therapy improves the survival of patients with bloodstream infections (BSI). We sought to determine if the sequence of administration of the first dose of antibiotic therapy (i.e., β-lactam or vancomycin, if both cannot be administered simultaneously) impacts early mortality for patients with BSI. METHODS We conducted a multicenter, observational study of patients ≥13 years with BSIs to evaluate the association of the sequence of antibiotic administration with 7-day mortality using inverse probability of treatment weighting (IPTW) incorporating propensity scores. Propensity scores were generated based on: demographics, Pitt bacteremia score, ICU status, highest lactate, highest WBC count, Charlson Comorbidity index, severe immunocompromise, administration of active empiric therapy, combination therapy, and time from emergency department arrival to first antibiotic dose. RESULTS Of 3,376 eligible patients, 2,685 (79.5%) received a β-lactam and 691 (20.5%) received vancomycin as their initial antibiotic. In the IPTW cohort, exposed and unexposed patients were similar on all baseline variables. Administration of a β-lactam agent prior to vancomycin protected against 7-day mortality (aOR 0.48 (95% CI: 0.33-0.69)]. Similar results were observed when evaluating 48-hour mortality (aOR 0.45 [95% CI: 0.24-0.83]). Administration of vancomycin prior to a β-lactam was not associated with improved survival in the subgroup of 524 patients with methicillin-resistant Staphylococcus aureus BSI (aOR 0.93 [95% CI: 0.33-2.63]). CONCLUSIONS For ill-appearing patients likely to be experiencing a BSI, prioritizing administration of a β-lactam over vancomycin may reduce early mortality, underscoring the significant impact of a relatively simple practice change on improving patient survival.
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Affiliation(s)
- Joe Amoah
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Chiotos
- Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Di Domenico EG, Marchesi F, Cavallo I, Toma L, Sivori F, Papa E, Spadea A, Cafarella G, Terrenato I, Prignano G, Pimpinelli F, Mastrofrancesco A, D’Agosto G, Trento E, Morrone A, Mengarelli A, Ensoli F. The Impact of Bacterial Biofilms on End-Organ Disease and Mortality in Patients with Hematologic Malignancies Developing a Bloodstream Infection. Microbiol Spectr 2021; 9:e0055021. [PMID: 34406812 PMCID: PMC8552682 DOI: 10.1128/spectrum.00550-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/22/2021] [Indexed: 11/20/2022] Open
Abstract
Bacterial bloodstream infection (BSI) represents a significant complication in hematologic patients. However, factors leading to BSI and progression to end-organ disease and death are understood only partially. The study analyzes host and microbial risk factors and assesses their impact on BSI development and mortality. A total of 96 patients with hematological malignancies and BSI were included in the study. Host-associated risk factors and all causes of mortality were analyzed by multivariable logistic regression at 30 days after BSI onset of the first neutropenic episode. The multidrug-resistant profile and biofilm production of bacterial isolates from primary BSI were included in the analysis. Median age was 60 years. The underlying diagnoses were acute leukemia (55%), lymphoma (31%), and myeloma (14%). A total of 96 bacterial isolates were isolated from BSIs. Escherichia coli was the most common isolate (29.2%). Multidrug-resistant bacteria caused 10.4% of bacteremia episodes. Weak biofilm producers (WBPs) were significantly (P < 0.0001) more abundant (72.2%) than strong biofilm producers (SBPs) (27.8%). Specifically, SBPs were 7.1% for E. coli, 93.7% for P. aeruginosa, 50% for K. pneumoniae, and 3.8% for coagulase-negative staphylococci. Mortality at day 30 was 8.3%, and all deaths were attributable to Gram-negative bacteria. About 22% of all BSIs were catheter-related BSIs (CRBSIs) and mostly caused by Gram-positive bacteria (79.0%). However, CRBSIs were not correlated with biofilm production levels (P = 0.75) and did not significantly impact the mortality rate (P = 0.62). Conversely, SBP bacteria were an independent risk factor (P = 0.018) for developing an end-organ disease. In addition, multivariate analysis indicated that SBPs (P = 0.013) and multidrug-resistant bacteria (P = 0.006) were independent risk factors associated with 30-day mortality. SBP and multidrug-resistant (MDR) bacteria caused a limited fraction of BSI in these patients. However, when present, SBPs raise the risk of end-organ disease and, together with an MDR phenotype, can independently and significantly concur at increasing the risk of death. IMPORTANCE Bacterial bloodstream infection (BSI) is a significant complication in hematologic patients and is associated with high mortality rates. Despite improvements in BSI management, factors leading to sepsis are understood only partially. This study analyzes the contribution of bacterial biofilm on BSI development and mortality in patients with hematological malignancies (HMs). In this work, weak biofilm producers (WBPs) were significantly more abundant than strong biofilm producers (SBPs). However, when present, SBP bacteria raised the risk of end-organ disease in HM patients developing a BSI. Besides, SBPs, together with a multidrug-resistant (MDR) phenotype, independently and significantly concur at increasing the risk of death in HM patients. The characterization of microbial biofilms may provide key information for the diagnosis and therapeutic management of BSI and may help develop novel strategies to either eradicate or control harmful microbial biofilms.
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Affiliation(s)
- Enea Gino Di Domenico
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppina Cafarella
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics and Bioinformatic Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Grazia Prignano
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Giovanna D’Agosto
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Elisabetta Trento
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, IRCCS San Gallicano Institute, Rome, Italy
| | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabrizio Ensoli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Tang Y, Xu C, Xiao H, Wang L, Cheng Q, Li X. Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies - The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study. Infect Drug Resist 2021; 14:3115-3124. [PMID: 34413656 PMCID: PMC8370111 DOI: 10.2147/idr.s322812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Enterobacteriaceae (EB) and non-fermentative bacteria (NFB) are the main pathogens responsible for gram-negative bloodstream infections (GN-BSI) in patients with hematological malignancies (HMs). These two pathogen types have heterogeneous resistance mechanisms to antibiotics. However, the impact of pathogen species and pattern of antibiotic resistance on the outcomes of patients with HMs remains unclear. Methods We retrospectively collected clinical data of patients with HMs at three comprehensive hospitals in Hunan Province, China, between January 2010 and May 2018. The data analyzed the impact that different species and patterns of antibiotic resistance had on the outcome of patients with HMs. Results The majority of the 835 monomicrobial isolates collected from patients with HMs and GN-BSIs were Enterobacteriaceae (75.7%). While detections of MDR pathogens in BSIs as a whole are decreasing, sub-analysis shows that detections of extended spectrum β-lactamase-producing (ESBL) Enterobacteriaceae and carbapenem-resistant pathogens in BISs are rising. Comparing different species, the early mortality rate associated with infections caused by NFB was significantly higher than infections caused by Enterobacteriaceae (22.6% vs 9.7%, p < 0.001). Across different multidrug-resistant (MDR) patterns, ESBL bacteria did not have a significant impact on health outcomes. Carbapenem-resistant bacteria, on the other hand, were observed to significantly affect early mortality rate, such as carbapenem-resistant Klebsiella pneumoniae (36.0% vs 7.6%, P < 0.001) and carbapenem-resistant non-fermentative bacteria (44.7% vs 16.5%, P < 0.001). Conclusion Our findings suggest that both species and patterns of antibiotic resistance can affect the early mortality of patients with HMs during BSI.
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Affiliation(s)
- Yishu Tang
- Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Cong Xu
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Han Xiao
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Liwen Wang
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qian Cheng
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Chen S, Lin K, Li Q, Luo X, Xiao M, Chen M, Zhu H, Chen Y, Wu X, Zeng Y, Zhang Y, Ally IH, Xu J, Ren J, Chen Z, Hu J, Yang T. A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy. J Cancer 2021; 12:5494-5505. [PMID: 34405012 PMCID: PMC8364636 DOI: 10.7150/jca.50802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Bloodstream infection (BSI) is a common and serious complication after patients with hematologic malignancies (HM) receiving chemotherapy. This study examined real-world data seeking to characterize HM BSI and identify risk factors for BSI emergence and mortality. Methods: We retrospectively analyzed the pathogenic epidemiology, antibiotic resistance, and BSI risk factors in a single-center cohort including 3014 consecutive patients with HM receiving chemotherapy between 2013 and 2016. Results of the pathogenic epidemiology were validated via comparison to available reported data. Results: We found that 725 patients (24.1%) had BSIs. Gram-negative (G-) bacteria represented 64.7% of the 744 isolated pathogenic strains, while Gram-positive (G+) bacteria and fungi accounted for 27.7% and 7.7% of the BSIs, respectively. The most common isolates were Klebsiella pneumoniae (19.2%), and 95.1% of the multidrug-resistant strains (MDR) were extended-spectrum beta-lactamase producing strains. G- bacteria were the main microflora responsible for BSI in our cohort of Chinese HM patients compared to studies in developed countries or in neutropenic children with HM or solid tumors. Multivariate analysis revealed that male sex, age ≥ 45 and < 65 yr, hospital length of stay ≥ 9d, neutropenia ≥ 7d before cultures, ≥ 2 antibiotics, and infections (gastrointestinal, perirectal, or urinary tract) independently predicted BSI emergence. Furthermore, age ≥ 65 yr, neutropenia ≥ 7d before blood cultures, no HM remission, lower white blood cell count, ≥ 3 antibiotics, respiratory infections, and Acinetobacter baumannii and Stenotrophomonas maltophilia BSI were independent predictors of 30-day mortality. Conclusions: G- bacteria were the predominant microflora during the study period and antibiotic resistance levels of the pathogens detected were high, especially for MDR strains. The mortality of BSI patients was high in this large cohort. Close attention should be paid to the risk factors identified here to facilitate timely and effective clinical management of such patients.
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Affiliation(s)
- Shaozhen Chen
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Kangni Lin
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Qian Li
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Xiaofeng Luo
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Min Xiao
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China.,Department of Cancer, Fujian Provincial Cancer Hospital, Fuzhou 350014, Fujian, P. R. China
| | - Minmin Chen
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Haojie Zhu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Yongquan Chen
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China.,Department of Hematology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, Fujian, P. R. China
| | - Xueqiong Wu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Yanling Zeng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China.,Department of Hematology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian, P.R. China
| | - Yuxin Zhang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China.,Department of Hematology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen 361015, Fujian, P.R. China
| | - Issa Hajji Ally
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Jingjing Xu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Jinhua Ren
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Zhizhe Chen
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Jianda Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
| | - Ting Yang
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
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Multidrug-resistant, gram-negative infections in high-risk haematologic patients: an update on epidemiology, diagnosis and treatment. Curr Opin Infect Dis 2021; 34:314-322. [PMID: 34117191 DOI: 10.1097/qco.0000000000000745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Multidrug-resistant Gram-negative bacilli (MDR-GNB) infections are a significant cause of morbidity and mortality in high-risk hematologic patients. Early diagnosis and management of antibiotic treatment in these patients is a challenge for physicians. This review focuses on the latest literature reports that concern the epidemiology, diagnosis and treatment of MDR-GNB infections in this population. RECENT FINDINGS High-risk haematological patients have several risk factors that make them particularly susceptible to MDR-GNB infections. Few studies have examined the implementation of rapid diagnostic methods for multidrug resistance, and their impact on management in this population. Inappropriate empiric antibiotic treatment in these patients has been described frequently and is associated with poor outcomes. SUMMARY Knowledge of the local epidemiology of MDR-GNB is a basic requirement to guide empiric antibiotic treatments in each centre. New diagnosic tests might help in faster identification of MDR-GNB infections. Appropriate empiric antibiotic treatment is crucial for improving patients' prognosis. Important strategies to reduce inadequate antibiotic treatment include better risk stratification for MDR-GNB infection and the introduction of new, more broad-spectrum antibiotic therapies.
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Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study. J Infect 2021; 83:306-313. [PMID: 34302864 PMCID: PMC8295054 DOI: 10.1016/j.jinf.2021.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/17/2021] [Indexed: 12/20/2022]
Abstract
Background We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.
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Impact of the Inclusion of an Aminoglycoside to the Initial Empirical Antibiotic Therapy for Gram-Negative Bloodstream Infections in Hematological Neutropenic Patients: a Propensity-Matched Cohort Study (AMINOLACTAM Study). Antimicrob Agents Chemother 2021; 65:e0004521. [PMID: 33972253 DOI: 10.1128/aac.00045-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To test the hypothesis that the addition of an aminoglycoside to a β-lactam antibiotic could provide better outcomes than β-lactam monotherapy for the initial empirical treatment of hematological neutropenic patients with subsequently documented Gram-negative bacillus (GNB) bloodstream infection (BSI), a multinational, retrospective, cohort study of GNB BSI episodes in hematological neutropenic patients in six centers (2010 to 2017) was conducted. Combination therapy (β-lactam plus aminoglycoside) was compared to β-lactam monotherapy. The primary endpoint was the case fatality rate, assessed at 7 and 30 days from BSI onset. Secondary endpoints were nephrotoxicity and persistent BSI. Propensity score (PS) matching was performed. Among 542 GNB BSI episodes, 304 (56%) were initially treated with combination therapy, with cefepime plus amikacin being most common (158/304 [52%]). Overall, Escherichia coli (273/304 [50.4%]) was the main etiological agent, followed by Pseudomonas aeruginosa, which predominated in the combination group (76/304 [25%] versus 28/238 [11.8%]; P < 0.001). Multidrug resistance rates were similar between groups (83/294 [28.2%] versus 63/233 [27%]; P = 0.95). In the multivariate analysis, combination therapy was associated with a lower 7-day case fatality rate (odds ratio [OR], 0.37; 95% CI, 0.14 to 0.91; P = 0.035) with a tendency toward lower mortality at 30 days (OR, 0.56; 95% CI, 0.29 to 1.08; P = 0.084). After PS matching, these differences remained for the 7-day case fatality rate (OR, 0.33; 95% CI, 0.13 to 0.82; P = 0.017). In addition, aminoglycoside use was not significantly associated with renal function impairment (OR, 1.12; 95% CI, 0.26 to 4.87; P = 0.9). The addition of an aminoglycoside to the initial empirical therapy regimen for febrile neutropenic hematological patients should be considered.
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Hospital-Acquired Blood Stream Infection in an Adult Intensive Care Unit. Crit Care Res Pract 2021; 2021:3652130. [PMID: 34285815 PMCID: PMC8275436 DOI: 10.1155/2021/3652130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hospital-acquired blood stream infections are a common and serious complication in critically ill patients. Methods A retrospective case series was undertaken investigating the incidence and causes of bacteraemia in an adult intensive care unit with a high proportion of postoperative cardiothoracic surgical and oncology patients. Results 405 eligible patients were admitted to the intensive care unit over the course of nine months. 12 of these patients developed a unit-acquired blood stream infection. The average Acute Physiology And Chronic Health Evaluation II (APACHE II) score of patients who developed bacteraemia was greater than that of those who did not (19.8 versus 16.8, respectively). The risk of developing bacteraemia was associated with intubation and higher rates of invasive procedures. The mortality rate amongst the group of patients that developed bacteraemia was 33%; this is in contrast to the mortality rate in our unit as 27.2%. There was a higher proportion of Gram-negative bacteria isolated on blood cultures (9 out of 13 isolates) than in intensive care units reported in other studies. Conclusion Critical-care patients are at risk of secondary bloodstream infection. This study highlights the importance of measures to reduce the risk of infection in the intensive-care setting, particularly in patients who have undergone invasive procedures.
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Choi WK, D'Sa A, Holman JN, Javed S, Thompson S, Nadgir RN. Chest CT Has Higher Yield for Infection than CT Sinus in Febrile Neutropenic Patients. Curr Probl Diagn Radiol 2021; 51:340-343. [PMID: 34334225 DOI: 10.1067/j.cpradiol.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/29/2021] [Accepted: 06/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Chest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting. METHODS Reports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed. Infection as reported was characterized as acute or worsening, improving, stable, indeterminate or negative. Results were tabulated and Pearson's chi-square test was used for comparison analysis. RESULTS Absence of infection on CT sinus was significantly higher than CT chest (86.1% vs. 58.5%; P<0.001). Conversely, CT chest had significantly higher incidence of acute or worsening infection than CT sinus (28.7% vs. 11.6%; P<0.001). CT chest also showed significantly higher incidence of improving infection compared to CT sinus (6.2% vs. 1.1%; P<0.001). There was no significant difference between incidence of stable infection on CT chest and CT sinus (1.1% vs. 0.2%; P=0.059). Infection was indeterminate in 5.5% of CT chest vs. 1% on CT sinus (P<0.001). CONCLUSIONS CT chest showed significantly higher diagnostic yield for acute infection than CT sinus, suggesting that sinusitis is less likely to be the source of fever than chest infections in febrile neutropenic patients. The majority of CT studies showed absence of infection, raising the question of the overall utility of routine surveillance CT imaging among this subset of patients.
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Affiliation(s)
- Won Kyu Choi
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Adam D'Sa
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Joseph N Holman
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Samrah Javed
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Sarah Thompson
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD
| | - Rohini N Nadgir
- Johns Hopkins Hospital: Johns Hopkins Medicine, 600 N. Wolfe Street, Phipps B-100, Baltimore, MD..
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Liu MA, Bakow BR, Hsu TC, Chen JY, Su KY, Asiedu EK, Hsu WT, Lee CC. Temporal Trends in Sepsis Incidence and Mortality in Patients With Cancer in the US Population. Am J Crit Care 2021; 30:e71-e79. [PMID: 34195781 DOI: 10.4037/ajcc2021632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few population-based studies assess the impact of cancer on sepsis incidence and mortality. OBJECTIVES To evaluate epidemiological trends of sepsis in patients with cancer. METHODS This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates. RESULTS The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival. CONCLUSIONS Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer.
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Affiliation(s)
- Michael A. Liu
- Michael A. Liu is a resident physician, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brianna R. Bakow
- Brianna R. Bakow is a fellow physician, Department of Hematology/Oncology, Warren Alpert Medical School of Brown University
| | - Tzu-Chun Hsu
- Tzu-Chun Hsu is a statistician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Yu Chen
- Jia-Yu Chen is a resident physician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ke-Ying Su
- Ke-Ying Su is a statistician, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Emmanuel K. Asiedu
- Emmanuel K. Asiedu is a resident physician, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wan-Ting Hsu
- Wan-Ting Hsu is a graduate student, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chien-Chang Lee
- Chien-Chang Lee is an attending physician and associate professor, Department of Emergency Medicine, National Taiwan University Hospital
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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 2021; 114:472-482. [PMID: 34170481 DOI: 10.1007/s12185-021-03183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Bloodstream infection (BSI) is a frequent complication observed in patients with febrile neutropenia (FN). BSI risk factors and incidence vary depending on chemotherapy types and prophylactic antimicrobial agents. We clarified these issues by post-hoc analysis of a prospective clinical trial cohort for severe FN in hematological malignancy. METHODS We performed an intention-to-treat analysis of 413 high-risk patients and 1272 blood culture sets. RESULTS Overall, 356 patients (86.2%) developed FN, and 20.8% had BSI complications. Prophylactic antimicrobials did not prevent complications of FN and BSI, but the incidence of BSIs of Gram-negative (GN) bacteria was lower than in the non-prophylaxis group (23.8% vs. 56.7%). Multinational Association of Supportive Care in Cancer (MASCC) scores < 20 were significantly correlated with the incidence of BSI, whereas MASCC scores > 21 were not (41.7% vs. 17.2%). The only significant risk factors were hypotension and dehydration. axillary temperatures were higher in GN-caused BSIs than in Gram-positive-caused BSIs and in patients with negative blood culture results (38.7 °C vs. 38.2 °C vs. 38.0 °C). The higher the fever, the higher the incidence of BSI and GN bacteremia. CONCLUSIONS MASCC score and axillary temperature are strong predictors of BSI. Non-administration of prophylactic antimicrobials and GN-caused BSI are correlated. THE CLINICAL TRIAL REGISTRATION NUMBER UMIN00010411.
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Åttman E, Syrjänen J, Lyytikäinen O, Ollgren J, Sinisalo M, Vuento R, Mattila E, Huttunen R. Healthcare-associated blood stream infections in hematological patients in Finland during the years 2006-2016. Eur J Haematol 2021; 107:311-317. [PMID: 33987847 DOI: 10.1111/ejh.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to identify the clinical characteristics, outcome, and antimicrobial susceptibility of healthcare-associated bloodstream infections (BSIs) in hematological patients. METHODS This retrospectively collected laboratory-based surveillance data include 3404 healthcare-associated BSIs in 2296 patients with a hematological malignancy in hospitals participating in the Finnish Hospital Infection Program from January 1, 2006, to December 31, 2016. RESULTS The most common underlying diseases were acute myelogenous leukemia (35%) and non-Hodgkin lymphoma (22%). Gram-positive organisms accounted for 60%-46% and gram-negative organisms for 24%-36% of BSIs in 2006-2016. The most common causative organism was coagulase-negative staphylococci (CoNS) (n = 731). The 7- and 28-day case fatality rates were 5.2% and 11.4%, respectively, and was highest in BSIs caused by Candida species (10.8% and 30.8%). The median age of patients increased from 59 years in 2006-2008 to 62 years in 2015-2016 (P < .01). Five percent of S aureus isolates were resistant to methicillin and five percent of Pseudomonas aeruginosa isolates were multidrug-resistant. Four percent of Klebsiella and seven percent of E coli isolates were resistant to ceftazidime. CONCLUSIONS The proportion of gram-positive bacteria decreased and gram-negative bacteria increased over time. The case fatality rate was low and the median age of patients increased during the study.
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Affiliation(s)
- Emilia Åttman
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Outi Lyytikäinen
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | | | - Erja Mattila
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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