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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...

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Autores principales: Laporte-Amargos, Julia, Sastre, Enric, Bergas, Alba, Pomares, Helena, Paviglianiti, Annalisa, Rodriguez-Arias, Marisol, Pallares, Natalia, Badia-Tejero, Ana Maria, Pons-Oltra, Paula, Carratalà, Jordi, Gudiol, Carlota
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963750/
https://www.ncbi.nlm.nih.gov/pubmed/36839500
http://dx.doi.org/10.3390/pathogens12020228
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author Laporte-Amargos, Julia
Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez-Arias, Marisol
Pallares, Natalia
Badia-Tejero, Ana Maria
Pons-Oltra, Paula
Carratalà, Jordi
Gudiol, Carlota
author_facet Laporte-Amargos, Julia
Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez-Arias, Marisol
Pallares, Natalia
Badia-Tejero, Ana Maria
Pons-Oltra, Paula
Carratalà, Jordi
Gudiol, Carlota
author_sort Laporte-Amargos, Julia
collection PubMed
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.
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spelling pubmed-99637502023-02-26 Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients Laporte-Amargos, Julia Sastre, Enric Bergas, Alba Pomares, Helena Paviglianiti, Annalisa Rodriguez-Arias, Marisol Pallares, Natalia Badia-Tejero, Ana Maria Pons-Oltra, Paula Carratalà, Jordi Gudiol, Carlota Pathogens Article 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. MDPI 2023-02-01 /pmc/articles/PMC9963750/ /pubmed/36839500 http://dx.doi.org/10.3390/pathogens12020228 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Laporte-Amargos, Julia
Sastre, Enric
Bergas, Alba
Pomares, Helena
Paviglianiti, Annalisa
Rodriguez-Arias, Marisol
Pallares, Natalia
Badia-Tejero, Ana Maria
Pons-Oltra, Paula
Carratalà, Jordi
Gudiol, Carlota
Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title 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_short Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
title_sort increasing gram-negative catheter-related bloodstream infection in cancer patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963750/
https://www.ncbi.nlm.nih.gov/pubmed/36839500
http://dx.doi.org/10.3390/pathogens12020228
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