Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients

Background: We aimed to assess the incidence, etiology and outcomes of catheter-related bloodstream infection (CRBSI) in onco-hematological patients, to assess the differences between patients with hematological malignancies (HMs) and solid tumors (STs) and to identify the risk factors for Gram-nega...

Descripción completa

Detalles Bibliográficos
Autores: Laporte Amargós, Júlia, Sastre, Enric, Bergas, Alba, Pomares, Helena, Paviglianiti, Annalisa, Rodriguez Arias, Marisol, Pallarès, Natàlia, Badía Tejero, Ana María, Pons Oltra, Paula, Carratalà, Jordi, Gudiol González, Carlota
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/197649
Acceso en línea:https://hdl.handle.net/2445/197649
Access Level:acceso abierto
Palabra clave:Hematologia
Bacteris gramnegatius
Hematology
Gram-negative bacteria
id ES_4d5b1cd4438f042e4bb5f33af4f4f11e
oai_identifier_str oai:diposit.ub.edu:2445/197649
network_acronym_str ES
network_name_str España
repository_id_str
spelling Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer PatientsLaporte Amargós, JúliaSastre, EnricBergas, AlbaPomares, HelenaPaviglianiti, AnnalisaRodriguez Arias, MarisolPallarès, NatàliaBadía Tejero, Ana MaríaPons Oltra, PaulaCarratalà, JordiGudiol González, CarlotaHematologiaBacteris gramnegatiusHematologyGram-negative bacteriaBackground: We aimed to assess the incidence, etiology and outcomes of catheter-related bloodstream infection (CRBSI) in onco-hematological patients, to assess the differences between patients with hematological malignancies (HMs) and solid tumors (STs) and to identify the risk factors for Gram-negative (GN) CRBSI. Methods: All consecutive episodes of BSI in adult cancer patients were prospectively collected (2006-2020). The etiology of CRBSI was analyzed in three different 5-year periods. Risk factors for GN CRBSI were assessed in the whole cohort and separately in patients with HMs and STs. Results: Among 467 episodes of monomicrobial CRBSI, 407 were Gram-positive (GP) (87.1%), 49 GN (10.5%) and 11 fungal (2.4%). Hematological patients (369 episodes) were more frequently neutropenic and were more likely to carry central venous catheters and develop GP CRBSI. Patients with STs (98 episodes) had more comorbidities, more frequently carried port reservoirs and commonly presented more GN CRBSI. GN CRBSI significantly increased over the study period, from 5.2% to 23% (p < 0.001), whereas GP CRBSI decreased from 93.4% to 73.3% (p < 0.001). CRBSI episodes involving port reservoirs and peripherally-inserted central catheters were significantly increased (p < 0.001). The most frequent GPs were coagulase-negative staphylococci (CoNS) (57.8%) and Pseudomonas aeruginosa was the most common GN (3%). Multidrug-resistant (MDR) GN represented 32.7% of all GN CRBSIs and increased over time (p = 0.008). The independent risk factors for GN CRBSI in the whole cohort were solid tumor, chronic kidney disease and carrying a port reservoir. Carrying a port reservoir was also a risk factor in patients with STs. Health-care acquisition was identified as a risk factor for GN CRBSI in the whole cohort, as well as in patients with STs and HMs. Inadequate empirical antibiotic treatment (IEAT) occurred regardless of the etiology: 49% for GNs and 48.6% for GPs (p = 0.96). In GP CRBSI, IEAT was mainly due to inadequate coverage against CoNS (87%), whereas in GN CRBSI, IEAT was associated with multidrug resistance (54.2%). Early (48 h and 7-day) and 30-day case-fatality rates were similar when analyzed according to the type of underlying disease and etiology, except for the 30-day case-fatality rate, which was higher in the group of patients with STs compared to those with HMs (21.5% vs. 12.5%, p = 0.027). The 48 h case-fatality rate was significantly higher in patients in whom the catheter had not been removed (5.6% vs. 1%; p = 0.011), and it remained significant for GP CRBSI (6% vs. 1.3%, p = 0.023). Conclusions: GNs are an increasing cause of CRBSI in cancer patients, particularly in solid tumor patients carrying port reservoirs. Multidrug resistance among GNs is also increasing and is associated with higher rates of IEAT. Decreased 48 h survival was associated with the non-removal of the catheter. These findings should be considered when deciding on early therapeutic management for cancer patients with suspected CRBSI.MDPI AG2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/197649Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.3390/pathogens12020228Pathogens, 2023, vol. 12, issue. 2, p. 228https://doi.org/10.3390/pathogens12020228cc by (c) Laporte Amargós, Júlia et al, 2023http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1976492026-05-27T06:46:51Z
dc.title.none.fl_str_mv Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
spellingShingle Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
Laporte Amargós, Júlia
Hematologia
Bacteris gramnegatius
Hematology
Gram-negative bacteria
title_short Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title_full Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title_fullStr Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title_full_unstemmed Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title_sort Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
dc.creator.none.fl_str_mv Laporte Amargós, Júlia
Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez Arias, Marisol
Pallarès, Natàlia
Badía Tejero, Ana María
Pons Oltra, Paula
Carratalà, Jordi
Gudiol González, Carlota
author Laporte Amargós, Júlia
author_facet Laporte Amargós, Júlia
Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez Arias, Marisol
Pallarès, Natàlia
Badía Tejero, Ana María
Pons Oltra, Paula
Carratalà, Jordi
Gudiol González, Carlota
author_role author
author2 Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez Arias, Marisol
Pallarès, Natàlia
Badía Tejero, Ana María
Pons Oltra, Paula
Carratalà, Jordi
Gudiol González, Carlota
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Hematologia
Bacteris gramnegatius
Hematology
Gram-negative bacteria
topic Hematologia
Bacteris gramnegatius
Hematology
Gram-negative bacteria
description Background: We aimed to assess the incidence, etiology and outcomes of catheter-related bloodstream infection (CRBSI) in onco-hematological patients, to assess the differences between patients with hematological malignancies (HMs) and solid tumors (STs) and to identify the risk factors for Gram-negative (GN) CRBSI. Methods: All consecutive episodes of BSI in adult cancer patients were prospectively collected (2006-2020). The etiology of CRBSI was analyzed in three different 5-year periods. Risk factors for GN CRBSI were assessed in the whole cohort and separately in patients with HMs and STs. Results: Among 467 episodes of monomicrobial CRBSI, 407 were Gram-positive (GP) (87.1%), 49 GN (10.5%) and 11 fungal (2.4%). Hematological patients (369 episodes) were more frequently neutropenic and were more likely to carry central venous catheters and develop GP CRBSI. Patients with STs (98 episodes) had more comorbidities, more frequently carried port reservoirs and commonly presented more GN CRBSI. GN CRBSI significantly increased over the study period, from 5.2% to 23% (p < 0.001), whereas GP CRBSI decreased from 93.4% to 73.3% (p < 0.001). CRBSI episodes involving port reservoirs and peripherally-inserted central catheters were significantly increased (p < 0.001). The most frequent GPs were coagulase-negative staphylococci (CoNS) (57.8%) and Pseudomonas aeruginosa was the most common GN (3%). Multidrug-resistant (MDR) GN represented 32.7% of all GN CRBSIs and increased over time (p = 0.008). The independent risk factors for GN CRBSI in the whole cohort were solid tumor, chronic kidney disease and carrying a port reservoir. Carrying a port reservoir was also a risk factor in patients with STs. Health-care acquisition was identified as a risk factor for GN CRBSI in the whole cohort, as well as in patients with STs and HMs. Inadequate empirical antibiotic treatment (IEAT) occurred regardless of the etiology: 49% for GNs and 48.6% for GPs (p = 0.96). In GP CRBSI, IEAT was mainly due to inadequate coverage against CoNS (87%), whereas in GN CRBSI, IEAT was associated with multidrug resistance (54.2%). Early (48 h and 7-day) and 30-day case-fatality rates were similar when analyzed according to the type of underlying disease and etiology, except for the 30-day case-fatality rate, which was higher in the group of patients with STs compared to those with HMs (21.5% vs. 12.5%, p = 0.027). The 48 h case-fatality rate was significantly higher in patients in whom the catheter had not been removed (5.6% vs. 1%; p = 0.011), and it remained significant for GP CRBSI (6% vs. 1.3%, p = 0.023). Conclusions: GNs are an increasing cause of CRBSI in cancer patients, particularly in solid tumor patients carrying port reservoirs. Multidrug resistance among GNs is also increasing and is associated with higher rates of IEAT. Decreased 48 h survival was associated with the non-removal of the catheter. These findings should be considered when deciding on early therapeutic management for cancer patients with suspected CRBSI.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/197649
url https://hdl.handle.net/2445/197649
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3390/pathogens12020228
Pathogens, 2023, vol. 12, issue. 2, p. 228
https://doi.org/10.3390/pathogens12020228
dc.rights.none.fl_str_mv cc by (c) Laporte Amargós, Júlia et al, 2023
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Laporte Amargós, Júlia et al, 2023
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI AG
publisher.none.fl_str_mv MDPI AG
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869407686201704448
score 15,301603

Similares en LA Referencia