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Observational Study
. 2024 Oct 26;13(11):933.
doi: 10.3390/pathogens13110933.

Epidemiology of Bacteremia in Patients with Hematological Malignancies and Hematopoietic Stem Cell Transplantation and the Impact of Antibiotic Resistance on Mortality: Data from a Multicenter Study in Argentina

Fabián Herrera  1 , Diego Torres  1 , Ana Laborde  2 , Rosana Jordán  3 , Lorena Berruezo  4 , Inés Roccia Rossi  5 , Noelia Mañez  6 , Lucas Tula  7 , María Laura Pereyra  8 , Andrea Nenna  9 , Patricia Costantini  10 , José Benso  11 , María Luz González Ibañez  2 , María José Eusebio  3 , Nadia Baldoni  4 , Laura Alicia Barcán  6 , Sandra Lambert  7 , Martín Luck  10 , Fernando Pasterán  12 , Alejandra Corso  12 , Melina Rapoport  12 , Federico Nicola  13 , María Cristina García Damiano  14 , Renata Monge  15 , Ruth Carbone  16 , Mariana Reynaldi  17 , Graciela Greco  18 , Miriam Blanco  19 , María Laura Chaves  20 , Marcelo Bronzi  21 , Alberto Carena  1 ; Argentine Group for the Study of Bacteremia in Cancer and Stem Cell Transplant (ROCAS)
Affiliations
Observational Study

Epidemiology of Bacteremia in Patients with Hematological Malignancies and Hematopoietic Stem Cell Transplantation and the Impact of Antibiotic Resistance on Mortality: Data from a Multicenter Study in Argentina

Fabián Herrera et al. Pathogens. .

Abstract

The epidemiology of bacteremia and the antibiotic resistance profile (ARP) of Gram-negative bacilli (GNB) in hematological malignancies (HM) and hematopoietic stem cell transplant (HSCT) patients may differ according to geographic region. In addition, multidrug-resistant organisms (MDROs) may impact mortality. This is a prospective, observational, and multicenter study. The first episodes of bacteremia in adult patients with HM or HSCT were included. The risk factors for 30-day mortality were identified. One thousand two hundred and seventy-seven episodes were included (HM: 920; HSCT: 357). GNB were isolated in 60.3% of episodes, with Enterobacterales (46.9%) and P. aeruginosa (8.5%) being the most frequent. Gram-positive cocci were isolated in 41.9% of episodes, with coagulase-negative staphylococci (19.8%) and S. aureus (10.4%) being the most frequent. MDROs were isolated in 40.2% (24.4% GNB). The ARP of GNB in patients with HM vs. HSCT was cefepime: 36.8% vs. 45.7% (p = 0.026); piperacillin-tazobactam: 31.05% vs. 45.2% (p < 0.0001); carbapenems: 18.9% vs. 27.3% (p = 0.012); and aminoglycosides: 9.3% vs. 15.4% (p = 0.017), respectively. Overall mortality between patients with HM and HSCT was 17.5% vs. 17.6% (p = 0.951), respectively. The risk factors for mortality were relapsed and refractory underlying disease, corticosteroids use, respiratory source, septic shock, and GNB resistant to meropenem, while 7-day clinical response was a protective factor for survival. Bacteremia was frequently caused by GNB, with a large proportion of MDROs and a high level of antibiotic resistance, especially in patients with HSCT. Carbapenem-resistant GNB bacteremia was associated with a significant increase in mortality.

Keywords: bacteremia; epidemiology; hematological malignancies; mortality; resistance.

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Conflict of interest statement

F.H. has participated in advisory boards and/or received speaker honoraria and grants from Gilead, Knight Therapeutics, Merck, Sharp & Dohme (MSD), SteinCares, Biomerieux, Rochem Biocare, and Pfizer. D.T. has participated in advisory boards and/or received speaker honoraria from Gilead, Knight Therapeutics, MSD, and GlaxoSmithKline. R.J. has participated in advisory boards and/or received speaker honoraria from Gilead and Pfizer. L.T. has received speaker honoraria from MSD. S.L. has received speaker honoraria from MSD and Pfizer. F.P. has received speaker honoraria from MSD and Pfizer. AAC is an employee of ROCHE Diagnostics with the role of Regional Medical Lead for Latin America. All other authors report no potential conflicts of interest.

Figures

Figure 1
Figure 1
Etiology of bacteremia episodes in patients with hematologic malignancies (HMs) vs. hematopoietic stem cell transplant recipients (HSCT). (A): Gram-negative bacilli. (B): Gram-positive cocci. Abbreviation: CoN-staphylococci: Coagulase-negative staphylococci. p-value obtained by chi-square or Fisher exact test.
Figure 2
Figure 2
Frequency and type of multidrug-resistant organisms in patients with hematologic malignancies (HMs) vs. hematopoietic stem cell transplant recipients (HSCT). Abbreviation: MDRO, multidrug-resistant organisms; MDR-GNB, multidrug-resistant Gram-negative bacilli; MDR-CoNS, multidrug-resistant coagulase-negative staphylococci; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant enterococci. p-value obtained by chi-square or Fisher exact test.
Figure 3
Figure 3
Resistant profiles (resistance percentage) of the Gram-negative bacilli bacteremia in patients with hematologic malignancies (HMs) vs. hematopoietic stem cell transplant (HSCT) recipients. Abbreviation: CIP, ciprofloxacin; CAZ, ceftazidime; FEP, cefepime; PIP-TAZ, piperacillin–tazobactam; MER, meropenem; AMK, amikacin; COL, colistin; TIG, tigecycline; FOS, fosfomycin; CAZ-AVI, ceftazidime–avibactam; CEFTOL-TAZ, ceftolozane–tazobactam. p-value obtained by chi-square or Fisher exact test.
Figure 4
Figure 4
Resistance mechanisms (or phenotype) of the Gram-negative bacilli bacteremia in patients with hematologic neoplasms (HMs) vs. hematopoietic stem cell transplant (HSCT) recipients. Abbreviation: ESBL-EB, extended-spectrum beta-lactamase-producing Enterobacterales; KPC-EB, Klebsiella pneumoniae carbapenemase-producing Enterobacterales; MDR-PAE, multidrug-resistant Pseudomonas aeruginosa; MDR-Acineto, multidrug-resistant Acinetobacter spp; Amp C-EB, Amp C-producing Enterobacterales; MDR-Steno, multidrug-resistant Stenotrophomonas maltophilia; OXA-48-like-producing Enterobacterales; MBL-EB, metallo-beta-lactamase-producing Enterobacterales; MDR-Burk, multidrug-resistant Burkholderia spp. p-value obtained by chi-square or Fisher exact test.
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