Evaluation of Enterobacterales bloodstream infections in hematologic cancer patients
Abstract
Purpose: In this study, we aimed to evaluate the clinical and laboratory findings of hospitalized patients with
Enterobacterales bacteremia/sepsis, the risk factors for mortality and the therapeutic options for treating
bloodstream infections (BSIs) caused by Enterobacterales.
Materials and methods: Patients hospitalized in the Oncology Hospital between January 2021 and December
2022 whose Enterobacterales species were isolated in blood cultures were included in the study. Blood cultures
were incubated in the Autobio BC120 device. Isolated microorganisms were named using a Vitek-2 (bioMerieux,
France) automated system. Antibiotic susceptibility tests were performed in the Vitek-2 system (bioMerieux,
France) and the disc diffusion method. In addition, the demographic and laboratory data of the patients were
evaluated. A total of 103 patients were included in the study during the two years. Only the first isolates from
each patient were included in the study.
Results: The distribution of Enterobacterales isolates grown in blood cultures, in order of frequency were
Escherichia coli (n:74, 63.25%), Klebsiella pneumoniae ssp pneumoniae (n:27, 23.1%), Klebsiella pneumoniae
ssp ozaenae (n:2, 1.71%), Klebsiella oxytoca (n:1, 0.85%), Enterobacter cloaceae complex (n:10, 6.84%),
Citrobacter freundii (n:1), Proteus mirabilis (n:1), Salmonella spp (n:1). The median (min-max) white blood cell
count was 1.51x103cells/uL (0.01-19.87), C-reactive protein (CRP) was 112.3 mg/L (0.06-546.0), procalcitonin
was 7.35 μg/L (0.05-61.21), time between blood culture collection and growing signal was 11.33 (3-58) hours
and the blood culture result report was three (1-8) days. Acute Myeloid Leukemia 40 (39.2%), B-cell Acute
Lymphoblastic leukemia 18 (17.6%), Multiple Myeloma 11 (10.8%), Diffuse Large B-cell Lymphoma 11 (10.8%)
were the most common diseases seen in Enterobacterales isolated patients from blood cultures.
Conclusion: Each hospital should conduct its evaluation and examine the patient profile to make the correct
empirical antibiotic selection. It is crucial to develop a suitable algorithm for this purpose.
Keywords
Enterobacterales, bloodstream infections, hematologic cancer patients
References
- 1. Santos ES, Lima ACM, Breda GL, et al. Colonization by multidrug-resistant bacteria in hematological patients undergoing hematopoietic stem cell transplantation and clinical outcomes: a single-center retrospective cohort study. Transpl Infect Dis 2023;25:e14119. https://doi.org/10.1111/tid.14119
- 2. Huang QS, Han TX, Fu HX, et al. Prognostic factors and outcomes in patients with septic shock after allogeneic hematopoietic stem cell transplantation. Transplant Cell Ther 2024;30:310(e1-11). https://doi.org/10.1016/j.jtct.2023.12.013
- 3. Zhou C, Jin L, Wang Q, et al. Bloodstream infections caused by carbapenem-resistant Enterobacterales: risk factors for mortality, antimicrobial therapy and treatment outcomes from a prospective multicenter study. Infect Drug Resist 2021;14:731-742. https://doi.org/10.2147/IDR.S294282
- 4. The European Committee on Antimicrobial Susceptibility Testing-EUCAST Guidelines for Clinical Break Point. Clinical Breakpoints-Bacteria (v 11.0), 2021 and (v 12.0), 2022. Available at: https://www.eucast.org/clinical_breakpoints. Accessed March 01, 2024
- 5. Boxer LA. How to approach neutropenia. Hematology Am Soc Hematol Educ Program 2012;2012:174-182. https://doi.org/10.1182/asheducation-2012.1.174
- 6. Hökenek UD, Özcan FG, Sevdi MS, Erkalp K, Selcan A. Mortality predictors in sepsis: a retrospective study. J Turk Soc Intens Care 2021;19:82-89. https://doi.org/10.4274/tybd.galenos.2020.30074
- 7. Busani S, Serafini G, Mantovani E, et al. Mortality in patients with septic shock by multidrug resistant bacteria: risk factors and impact of sepsis treatments. J Intensive Care Med 2019;34:48-54. https://doi.org/10.1177/0885066616688165
- 8. Kalaycı ÇZ, Behçet M, Avcıoğlu F, Afşar Y, Şentürk E, Kurtoğlu M. Kan kültürü örneklerinden izole edilen gram negatif bakterilerin antibiyotik direnç profillerinin incelenmesi. Value in Health Sciences 2023;13:80-86. https://doi.org/10.33631/sabd.1133713
- 9. Li Y, Li J, Hu T, et al. Five-year change of prevalence and risk factors for infection and mortality of CRKP bloodstream infection in a tertiary hospital in North China. Antimicrob Resist Infect Control 2020;9:79. https://doi.org/10.1186/s13756-020-00728-3
- 10. Sava M, Bättig V, Gerull S, et al. Bloodstream infections in allogeneic haematopoietic cell recipients from the Swiss Transplant Cohort Study: trends of causative pathogens and resistance rates. Bone Marrow Transplant 2023;58:115-118. https://doi.org/10.1038/s41409-022-01851-y
