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. 2025 Jul 4;7(4):dlaf116.
doi: 10.1093/jacamr/dlaf116. eCollection 2025 Aug.

Impact of multidrug resistance in cancer patients with bloodstream infections caused by Gram-negative bacilli: results from a multicentre study

Marco Falcone  1 , Sergio Carbonara  2 , Andrea Marino  3 , Giovanni Di Caprio  4 , Anna Carretta  5 , Alessandra Mularoni  6 , Michele Fabiano Mariani  7 , Alberto Enrico Maraolo  8 , Lidia Dalfino  9 , Lorenzo Corbo  10 , Alice Annalisa Medaglia  11 , Christian Sgroi  12 , Rosa Fontana Del Vecchio  13 , Giancarlo Ceccarelli  14 , Antonio Albanese  15 , Calogero Buscemi  16 , Simona Talamanca  17 , Giuseppe Foti  18 , Antonina Franco  13 , Carmelo Iacobello  19 , Salvatore Corrao  20 , Domenico Morana  12 , Filippo Pieralli  21 , Ivan Gentile  8 , Teresa Santantonio  5 , Antonio Cascio  22 , Nicola Coppola  23 , Bruno Cacopardo  3 , Mario Venditti  14 , Francesco Menichetti  1   24 , Giusy Tiseo  1
Affiliations

Impact of multidrug resistance in cancer patients with bloodstream infections caused by Gram-negative bacilli: results from a multicentre study

Marco Falcone et al. JAC Antimicrob Resist. .

Abstract

Objective: To evaluate the impact of multidrug resistance (MDR) on the mortality of cancer patients with bloodstream infection (BSI) by Gram-negative bacilli (GNB).

Patients and methods: This was a prospective observational multicentre study including cancer patients with BSI caused by GNB (June 2018-January 2020). The primary outcome was 30-day mortality. The secondary outcome was mortality attributable to MDR organisms, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant (CR) Enterobacterales and CR non-fermenting GNB (CR-NFGNB). A multivariable regression analysis identified factors associated with 30-day mortality. Adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) were calculated. Attributable mortality was estimated according to DRIVE-AB Consortium's formula.

Results: Of 347 cancer patients, 232 (66.9%) had BSI caused by MDR-GNB. Thirty-day mortality was 27.2% in patients with BSI caused by MDR organisms compared to 7% in those with BSI by susceptible GNB (P < 0.001). In the multivariable analysis, MDR-GNB including ESBL-producing Enterobacterales (aOR 8.734, 95% CI 1.411-54.077, P = 0.02), KPC-producing Enterobacterales (aOR 8.548, 95% CI 1.296-56.411, P = 0.026), metallo-β-lactamases (MBL)-producing Enterobacterales (aOR 15.802, 95% CI 1.408-68.667, P = 0.022) and CR-NFGNB (aOR 53.373, 95% CI 5.104-89.146, P < 0.001) as compared to susceptible GNB were independently associated with 30-day mortality. Mortality attributable to MDR-GNB was 43%. According to causative pathogens, attributable mortality was 33% in ESBL, 32% in KPC, 47% in MBL and 73% in CR-NFGNB.

Conclusions: In cancer patients, BSIs due to MDR-GNB are associated with excess mortality compared to BSI by susceptible GNB. Strategies to reduce the spread of MDR-GNB and to promote optimal management of affected patients are urgently needed.

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Figures

Figure 1.
Figure 1.
The description of causative GNB among cancer patients with BSI.
Figure 2.
Figure 2.
Thirty-day mortality rates of cancer patients with BSI due to GNB according to causative pathogens.
See this image and copyright information in PMC

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