Abstract
BackgroundThe colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients.MethodsPubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results.Results6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.ConclusionsOur study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.
Highlights
The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy
The results showed that in patients with malignancy, ESBL-PE infections were associated with a higher mortality risk from BSIs than non-ESBL-PE infections (RR = 2.21, 95% Confidence interval (CI): 1.60–3.06, P < 0.001) (Fig. 2), with a significant between-study heterogeneity (I2 = 78.3%, P < 0.001)
In this meta-analysis, we included 19 studies that both enrolled oncological patients with ESBL-PE and non-ESBL-PE infections, and the results showed that the mortality in BSIs caused by ESBL-PE among patients with malignancy was higher compared with non-ESBLPE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001)
Summary
The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. Patients with malignancy are more vulnerable to developing severe infection, including those caused by ESBL-PE since they are more likely to be immunocompromised due to chemotherapy, radiotherapy, surgery, invasive procedures, malnutrition, and malignancy itself [4, 5]. As a result, these infections have become significant therapeutic challenges for clinicians due to delayed initiation of chemotherapy, reduced standard dosage, prolonged hospitalization, increased financial burden on healthcare, and raised severe morbidity and mortality [3, 6]. Rapid initiation of appropriate antibiotic therapy is pivotal for oncological patients with BSIs caused by ESBL-PE, [4] while inappropriate empirical antibiotic treatment is associated with worse outcomes and survival [3]
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