Infections Due to Multidrug-Resistant Bacteria in Oncological Patients: Insights from a Five-Year Epidemiological and Clinical Analysis.

Eleni Isidora A Perdikouri,Eleni Siskou,Anna Bettina Haidich,Dimitrios Lathyris,Kostoula Arvaniti,Christos Papandreou,Fani Apostolidou Kiouti

doi:10.3390/microorganisms7090277

Eleni Isidora A Perdikouri, Eleni Siskou + Show 5 more

Open Access

https://doi.org/10.3390/microorganisms7090277

Copy DOI

Abstract

Bacterial infections are frequent complications in cancer patients. Among them, those caused by multidrug-resistant (MDR) bacteria increase morbidity and mortality mainly because of limited therapeutic options. Current knowledge regarding MDR infections in patients with solid tumors is limited. We assessed the epidemiology and risk factors of increased mortality in these patients. In this retrospective five-year single cohort observational study, we included all oncological patients with MDR infections. Cancer-related parameters, comorbidities, prior use of antibiotics, previous surgical interventions and hospitalization, as well as the use of invasive procedures were investigated as potential risk factors causing adverse outcomes. Seventy-three patients with MDR infection were included: 37% with carbapenem-resistant Klebsiella pneumoniae, 24% with oxacillin-resistant Staphylococcus aureus (MRSA) and 21% with carbapenem-resistant Acinetobacter baumanni. Previous colonization with MDR bacteria was detected in 14% patients, while 20% of the patients presented MDR colonization or infection at ward admission. Mortality during the infection episode was 32%. Duration of hospitalization and CRP were statistically significant risk factors of mortality, whereas administration of guided antibiotics was a protective factor. Knowledge of local epidemiology of MDR bacteria can help physicians promptly identify cancer patients at risk of MDR infections and initiate timely effective empirical antibiotic treatment that can eventually improve the overall therapeutic management.

Highlights

Bacterial infection is one of the most frequent complications in immunosuppressed cancer patients, concerning both solid and hematological malignancies
We aimed to describe the clinical characteristics of all patients with MDR infections during the five-year study period and to present mortality with its associated predictors
We showed that the difficulties in treatment of MDR infections and the easy spread of those bacteria concern typical patient populations, such as critically ill patients in Intensive Care Unit (ICU) settings, but, oncological patients that, until recently, were considered a patient population of little concern for MDR infection

Summary

Introduction

Bacterial infection is one of the most frequent complications in immunosuppressed cancer patients, concerning both solid and hematological malignancies. Cancer patients, frequently cared for and hospitalized in healthcare structures, are affected by MDR infections often associated with considerable morbidity, mortality and financial burden [2,3]. Changes in global epidemiology of infections in oncological patients have occurred overtime, characterized by a shift from prevalent Gram-negative bacteria between the 1960s and 1970s to Gram-positive ones ten years later and, beyond this, a new restitution of Gram-negative bacteria in the last 20 years in many countries [4,5,6]. Most existing guidelines propose antibiotic schemes for neutropenic or septic oncological patients, whereas empirical antibiotic regimens for suspected MDR infection in non-neutropenic and non-septic cancer patients are not clearly defined [11,12,13]. Inadequate antibiotic treatment, either empirical or guided by antibiotic susceptibility tests, exposes patients to increased risk of adverse outcome, especially in neutropenic bacteremic patients suffering from MDR infections [2,8,10,14,15,16]

Objectives

Methods

Results

Discussion

Conclusion