J Cancer 2021; 12(18):5494-5505. doi:10.7150/jca.50802 This issue

Research Paper

A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy

Shaozhen Chen1*, Kangni Lin1*, Qian Li1*, Xiaofeng Luo1, Min Xiao1,2, Minmin Chen1, Haojie Zhu1, Yongquan Chen1,3, Xueqiong Wu1, Yanling Zeng1,4, Yuxin Zhang1,5, Issa Hajji Ally1, Jingjing Xu1, Jinhua Ren1, Zhizhe Chen1, Jianda Hu1✉, Ting Yang1✉

1. Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, P. R. China
2. Department of Cancer, Fujian Provincial Cancer Hospital, Fuzhou 350014, Fujian, P. R. China
3. Department of Hematology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, Fujian, P. R. China
4. Department of Hematology, Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian, P.R. China
5. Department of Hematology, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen 361015, Fujian, P.R. China
* These authors contributed equally to this work as co-authors.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Chen S, Lin K, Li Q, Luo X, Xiao M, Chen M, Zhu H, Chen Y, Wu X, Zeng Y, Zhang Y, Ally IH, Xu J, Ren J, Chen Z, Hu J, Yang T. A practical update on the epidemiology and risk factors for the emergence and mortality of bloodstream infections from real-world data of 3014 hematological malignancy patients receiving chemotherapy. J Cancer 2021; 12(18):5494-5505. doi:10.7150/jca.50802. Available from https://www.jcancer.org/v12p5494.htm

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Graphic abstract

Background: Bloodstream infection (BSI) is a common and serious complication after patients with hematologic malignancies (HM) receiving chemotherapy. This study examined real-world data seeking to characterize HM BSI and identify risk factors for BSI emergence and mortality.

Methods: We retrospectively analyzed the pathogenic epidemiology, antibiotic resistance, and BSI risk factors in a single-center cohort including 3014 consecutive patients with HM receiving chemotherapy between 2013 and 2016. Results of the pathogenic epidemiology were validated via comparison to available reported data.

Results: We found that 725 patients (24.1%) had BSIs. Gram-negative (G-) bacteria represented 64.7% of the 744 isolated pathogenic strains, while Gram-positive (G+) bacteria and fungi accounted for 27.7% and 7.7% of the BSIs, respectively. The most common isolates were Klebsiella pneumoniae (19.2%), and 95.1% of the multidrug-resistant strains (MDR) were extended-spectrum beta-lactamase producing strains. G- bacteria were the main microflora responsible for BSI in our cohort of Chinese HM patients compared to studies in developed countries or in neutropenic children with HM or solid tumors. Multivariate analysis revealed that male sex, age ≥ 45 and < 65 yr, hospital length of stay ≥ 9d, neutropenia ≥ 7d before cultures, ≥ 2 antibiotics, and infections (gastrointestinal, perirectal, or urinary tract) independently predicted BSI emergence. Furthermore, age ≥ 65 yr, neutropenia ≥ 7d before blood cultures, no HM remission, lower white blood cell count, ≥ 3 antibiotics, respiratory infections, and Acinetobacter baumannii and Stenotrophomonas maltophilia BSI were independent predictors of 30-day mortality.

Conclusions: G- bacteria were the predominant microflora during the study period and antibiotic resistance levels of the pathogens detected were high, especially for MDR strains. The mortality of BSI patients was high in this large cohort. Close attention should be paid to the risk factors identified here to facilitate timely and effective clinical management of such patients.

Keywords: Bloodstream infections, hematological malignancy, pathogen, resistance, risk factor