Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients
Abstract
:1. Introduction
2. Methods
2.1. Setting, Study Population and Study Design
2.2. Definitions
2.3. Microbiologic Studies
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Rates of CRBSI
3.3. Etiology
3.4. Risk Factors for GN CRBSI
3.5. Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Characteristic | Hematological Malignancies N = 369 (%) | Solid Tumors N = 98 (%) | Total N = 467 (%) | p Value |
---|---|---|---|---|
Age (years, mean, SD) | 53.1 (15) | 55.5 (13.3) | ||
Male sex | 225 (61.1) | 52 (53.1) | 277 (59.4) | 0.092 |
Hematological malignancies Acute leukemia Lymphoma Multiple myeloma Myelodysplastic syndrome Aplastic anemia Chronic myeloid leukemia Other 1 Hematopoietic stem cell transplant | 207 (56) 84 (22.8) 49 (13.3) 8 (2.17) 8 (2.17) 8 (2.17) 5 (1.35) 142 (38.5) | |||
Solid tumors Breast cancer Colorectal cancer Head and Neck cancer Gynecological cancer Lung cancer Hepatobilliary tumor Other 2 | 24 (24.4) 23 (23.4) 11 (11.2) 10 (10.2) 9 (9.1) 5 (5.1) 16 (16.3) | |||
Comorbidities Diabetes mellitus Chronic obstructive pulmonary disease Chronic heart disease Chronic renal disease Chronic liver disease | 92 (25) 38 (10.3) 21 (5.7) 18 (4.9) 11 (3) 8 (2.2) | 36 (36.7) 14 (14.3) 3 (3.1) 6 (6.1) 3 (3.1) 6 (6.1) | 128 (27.4) 52 (11.1) 24 (5.1) 24 (5.1) 14 (3) 14 (3) | 0.020 0.265 0.295 0.620 1.00 0.086 |
Immunosuppressive therapy Previous chemotherapy (1 month) Previous corticosteroids | 280 (76) 100 (27.1) | 71 (72.4) 35 (36.1) | 351 (75.2) 135 (29) | 0.485 0.083 |
Neutropenia < 500cells/mm3 | 212 (57.6) | 11 (11.2) | 223 (48) | <0.001 |
High-risk MASCC index score | 64 (28.7) | 3 (25) | 67 (28.5) | 1.00 |
Parenteral nutrition | 26 (7) | 16 (16.3) | 42 (9) | 0.004 |
Previous antibiotic therapy (1 month) | 196 (53.1) | 39 (39.8) | 235 (50.3) | 0.019 |
Nosocomial acquisition | 290 (78.6) | 49 (50) | 339 (72.6) | <0.001 |
Type of catheter Peripheral PICC Central venous catheter Port reservoir | 37 (10) 21 (5.7) 306 (82.9) 4 (1.1) | 23 (23.5) 12 (12.2) 18 (18.4) 44 (45) | 60 (12.9) 33 (7.1) 324 (69.4) 48 (10.3) | 0.001 0.024 <0.001 <0.001 |
Etiology of CRBSI Gram-positive Gram-negative Fungi MDRGNB | 332 (90) 31 (8.7) 6 (1.6) 11 (3) | 75 (76.5) 18 (18.4) 5 (5.1) 6 (6.1) | 407 (87.2) 49 (10.5) 11 (2.36) 17 (3.6) | <0.001 0.004 0.058 0.141 |
Septic shock at presentation | 18 (4.9) | 6 (6.1) | 24 (5.1) | 0.620 |
Inadequate empirical antibiotic therapy | 182 (49.6) | 48 (49) | 230 (49.5) | 0.914 |
Catheter removal | 289 (78.5) | 89 (91.8) | 378 (81.3) | 0.003 |
Intensive care unit admission | 20 (5.4) | 3 (3.1) | 23 (4.9) | 0.438 |
Case-fatality rates Overall 30-days 7-days 48-h | 46 (12.5) 18 (4.9) 7 (1.9) | 20 (21.5) 6 (6.2) 1 (1) | 66 (14.3) 24 (5.2) 8 (1.7) | 0.027 0.608 1.00 |
2006–2010 N = 183 (39.2%) | 2011–2015 N = 168 (36%) | 2016–2020 N = 116 (24.8%) | Total N = 467 (%) | p Value | |
---|---|---|---|---|---|
Gram-positive Gram-negative Fungi MDRGNB | 171 (93.4) 10 (5.4) 2 (1.09) 4 (2.2) | 151 (89.9) 13 (7.7) 4 (2.3) 3 (1.8) | 85 (73.3) 26 (22.4) 5 (4.3) 10 (8.7) | 407 (87.1) 49 (10.5) 11 (2.4) 17 (3.6) | <0.001 <0.001 0.076 0.008 |
CVC Peripheral Port reservoir PICC | 125 (68.3) 41 (22.4) 12 (6.5) 5 (2.7) | 120 (71.4) 18 (10.7) 16 (9.59 14 (8.3) | 79 (68.1) 1 (0.86) 20 (17.2) 16 (13.8) | 324 (69.3) 60 (12.4) 48 (10.2) 35 (7.5) | 0.951 <0.001 0.004 <0.001 |
N | (%) | |
---|---|---|
GRAM-NEGATIVE | 49 | 10.5 |
Pseudomonas aeruginosa | 14 | 3.0 |
Klebsiella spp. | 11 | 2.4 |
Enterobacter spp. | 7 | 1.5 |
Escherichia coli | 5 | 1.1 |
Stenotrophomonas maltophilia | 5 | 1.1 |
Other 1 | 7 | 1.3 |
MDRGNB 2 | 17 | 3.7 |
GRAM-POSITIVE | 407 | 87.1 |
Coagulase-negative staphylococci | 268 | 57.8 |
Staphylococcus aureus | 106 | 22.8 |
Methicillin-resistant S. aureus | 12 | 2.6 |
Enterococcus faecium | 10 | 2.2 |
Enterococcus faecalis | 9 | 1.9 |
Corynebacterium spp. | 4 | 0.9 |
Bacillus cereus | 3 | 0.6 |
Other 3 | 7 | 1.5 |
FUNGI | 11 | 2.4 |
Candida parapsilosis | 5 | 1.2 |
Candida albicans | 2 | 0.4 |
Candida krusei | 2 | 0.2 |
Candida glabrata | 1 | 0.2 |
Candida tropicalis | 1 | 0.2 |
Characteristic | Gram-Positive N = 407 (%) | Gram-Negative N = 49 (%) | p Value |
---|---|---|---|
Age (years, mean, SD) | 53.5 (±13.5) | 53.7 (±14.3) | 0.919 |
Male sex | 244 (60) | 28 (57.1) | 0.82 |
Hematologic malignancy Solid tumor | 323 (81.6) 75 (18.4) | 31 (63.3) 18 (36.7) | 0.005 |
HSCT (N = 140) | 133 (32.7) | 7 (14.3) | 0.013 |
Comorbidities
| 106 (26) 8 (2) | 17 (34.7) 5 (10.2) | 0.26 0.008 |
Neutropenia | 209 (51.4) | 13 (27.1) | 0.002 |
High risk MASCC score (N = 234) | 58 (27.5) | 8 (53.3) | 0.036 |
Previous antibiotics (1 month) | 203 (49.9) | 24 (49.0) | 1.00 |
Health-care acquisition | 96 (23.6) | 30 (61.2) | <0.001 |
Bacterial prophylaxis | 26 (6.4) | 1 (2) | 0.34 |
Type of catheter
| 54 (13.3) 32 (7.9) 288 (70.8) 33 (8.1) | 2 (4.1) 2 (4.1) 32 (65.3) 13 (26.5) | 0.064 0.56 0.53 <0.001 |
Hypotension (<80 mmHg) | 34 (10.9) | 9 (19.1) | 0.169 |
Septic shock | 20 (4.9) | 4 (6.1) | 0.72 |
Inadequate empirical antibiotic therapy a
| 196 (48.4) 89 (45.4) 29 (14.9) 11 (5.6) 1 (0.5) 68 (34.7) 12 (6.1) 4 (2.0) | 25 (51) 8 (32.0) 5 (20.0) 2 (8.0) 0 4 (16.0) 0 0 | 0.93 |
Case-fatality rates
| 8 (2) 20 (5.2) 54 (13.5) | 0 4 (8.2) 9 (18.4) | 1.00 0.32 0.35 |
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Laporte-Amargos, J.; Sastre, E.; Bergas, A.; Pomares, H.; Paviglianiti, A.; Rodriguez-Arias, M.; Pallares, N.; Badia-Tejero, A.M.; Pons-Oltra, P.; Carratalà, J.; et al. Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients. Pathogens 2023, 12, 228. https://doi.org/10.3390/pathogens12020228
Laporte-Amargos J, Sastre E, Bergas A, Pomares H, Paviglianiti A, Rodriguez-Arias M, Pallares N, Badia-Tejero AM, Pons-Oltra P, Carratalà J, et al. Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients. Pathogens. 2023; 12(2):228. https://doi.org/10.3390/pathogens12020228
Chicago/Turabian StyleLaporte-Amargos, Julia, Enric Sastre, Alba Bergas, Helena Pomares, Annalisa Paviglianiti, Marisol Rodriguez-Arias, Natalia Pallares, Ana Maria Badia-Tejero, Paula Pons-Oltra, Jordi Carratalà, and et al. 2023. "Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients" Pathogens 12, no. 2: 228. https://doi.org/10.3390/pathogens12020228
APA StyleLaporte-Amargos, J., Sastre, E., Bergas, A., Pomares, H., Paviglianiti, A., Rodriguez-Arias, M., Pallares, N., Badia-Tejero, A. M., Pons-Oltra, P., Carratalà, J., & Gudiol, C. (2023). Increasing Gram-Negative Catheter-Related Bloodstream Infection in Cancer Patients. Pathogens, 12(2), 228. https://doi.org/10.3390/pathogens12020228