Abstract
In developed countries, hematological malignancies (HM) account for 8 to 10% of cancers diagnosed annually and one-third of patients with HM (HMP) are expected to die from their disease. The former wide spectrum “magic bullet,” imipenem, has been ousted by the emergence of carbapenem resistant (CR) pathogens. In endemic areas, infections with CR-bacteria occur in vulnerable patients, notably in HMP, who suffer from high mortality related to infectious complications. In this work, we reviewed epidemiologic and clinical factors associated with CR-infections in adult HMP and data on CR-related mortality and antibiotic treatments in this population. We found that resistance profile of strains involved in HMP infections, mainly bacteremia, reflect local epidemiology. Significant risk factors for infections with CR-bacteria include sex male, age around 50 years old, acute leukemia, selvage chemotherapy, neutropenia, and digestive colonization by CR-bacteria. Mortality rate is high in HMP infected with CR-Enterobacteriaceae, more particularly in case of acute myeloid leukemia and unresolved neutropenia, due to inappropriate empiric management and delayed administration of targeted antibiotics, such as tigecycline, colistin, or new associations of active drugs. Thus, we developed an algorithm for clinicians, assessing the incremental risk for CR-bacterial infection occurrence and mortality in febrile HMP, to guide decisions related to empirical therapeutic strategies.
Highlights
In economically developed regions of the world, 8 to 10% of the annual new cancer diagnoses account for hematological malignancies (HM) and one-third of the HM patients are expected to die of their disease (Chen and Chen, 2014; Errahhali et al, 2016; Batista et al, 2017; Medecine Matters, 2020)1
The following data were extracted from each study: study type, region, published year, study period, number of patients included, age, HM-type, CRbacterial genera or species, sample, carbapenem resistant (CR) mechanism, antibiotic susceptibility profile of CR bacteria, comorbidity, significative risk factors associated with occurrence of CR bacteria, mortality associated with CR bacteria, significative risk factors of mortality associated with CR bacteria, and provided antibiotic treatments
Thirteen publications reported some significative risk factors associated with occurrence of CR bacteria in HM patients (Table 1)
Summary
In economically developed regions of the world, 8 to 10% of the annual new cancer diagnoses account for hematological malignancies (HM) and one-third of the HM patients are expected to die of their disease (Chen and Chen, 2014; Errahhali et al, 2016; Batista et al, 2017; Medecine Matters, 2020). Infection-related mortality in HM patients can be high due to weak immune systems and the accumulation of various factors such as neutropenia, excessive or repeated chemotherapy, long hospital stays, and hospital-acquired infections
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