Evaluation of Enterobacterales bloodstream infections in hematologic cancer patients

Yıl 2025, Cilt: 18 Sayı: 2, 2 - 2

Esra Tavukcu , Ferzan Arslan , Serap Suzuk , Ayşe Güreser , İpek Mumcuoğlu , Nese Inan , Turgay Ulaş , Tuba Dal

https://doi.org/10.31362/patd.1513010

Öz

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.

Anahtar Kelimeler

Enterobacterales, bloodstream infections, hematologic cancer patients

Hematolojik kanser hastalarında Enterobacterales kan dolaşımı enfeksiyonlarının değerlendirilmesi

Öz

Amaç: Bu çalışmada Enterobacterales bakteriyemisi/sepsisi nedeniyle hastaneye yatırılan hastaların klinik ve laboratuvar bulgularını, mortalite için risk faktörlerini ve Enterobacterales'in neden olduğu kan dolaşımı enfeksiyonlarının (KDE) tedavisine yönelik tedavi seçeneklerini değerlendirmeyi amaçladık.
Gereç ve yöntem: Çalışmaya Ocak 2021 ile Aralık 2022 tarihleri arasında Onkoloji Hastanesi'nde yatan ve kan kültürlerinde Enterobacterales türlerine rastlanan hastalar dahil edildi. Kan kültürleri Autobio BC120 cihazında inkübe edildi. İzole edilen mikroorganizmalar Vitek-2 (bioMerieux, Fransa) otomatize sistem kullanılarak adlandırıldı. Antibiyotik duyarlılık testleri hem Vitek-2 sistemi (bioMerieux, Fransa) hem de disk difüzyon yöntemiyle yapıldı. Ayrıca, hastaların demografik ve laboratuvar verileri değerlendirildi. İki yıllık dönemde toplam 103 hasta çalışmaya dahil edildi. Her hastadan sadece ilk izolatlar çalışmaya dahil edildi.
Bulgular: Kan kültürlerinde üreyen Enterobacterales izolatlarının dağılımı sıklık sırasına göre; Escherichia coli (%63.25, n:74), Klebsiella pneumoniae ssp pneumoniae (%23.1, n:27), Klebsiella pneumoniae ssp ozaenae (%1.71, n:2), Klebsiella oxytoca (%0.85, n:1), Enterobacter cloaceae kompleks (%6.84, n:10), Citrobacter freundii (n:1), Proteus mirabilis (n:1), Salmonella spp (n:1) şeklindeydi. Ortalama (minimum-maksimum) lökosit sayısı 1.51x103 hücre/uL (0.01-19.87), C-reaktif protein (CRP) 112.3 mg/L (0.06-546.0), prokalsitonin 7.35 µg/L (0.05-61.21), kan kültürünün alınmasıyla üreme sinyali arasında geçen süre 11,33 (3-58) saat ve kan kültürü sonuç raporu üç (1-8) gün olarak belirlendi. Kan kültürlerinden Enterobacterales izole edilen hastalarda; Akut Myeloid Lösemi 40 (%39.2), B-hücreli Akut Lenfoblastik Lösemi 18 (%17.6), Multiple Myelom 11 (%10.8), Diffüz Büyük B-hücreli Lenfoma 11 (%10.8) en sık görülen hastalıklardı.
Sonuç: Doğru ampirik antibiyotik seçimini yapabilmek için her hastane kendi değerlendirmesini yapmalı ve hasta profilini incelemelidir. Bu amaçla uygun bir algoritma geliştirmek son derece önemlidir.

Anahtar Kelimeler

Enterobacterales, kan dolaşımı enfeksiyonları, hematolojik kanser hastaları

Kaynakça

• 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
• 11. Carreira AS, Salas MQ, Remberger M, et al. Bloodstream infections and outcomes following allogeneic hematopoietic cell transplantation: a single-center study. Transplant Cell Ther 2022;28:50(e1-8). https://doi.org/10.1016/j.jtct.2021.10.008
• 12. Blennow O, Ljungman P, Sparrelid E, Mattsson J, Remberger M. Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations. Transpl Infect Dis 2014;16:106-114. https://doi.org/10.1111/tid.12175
• 13. Mikulska M, Del Bono V, Raiola AM, et al. Blood stream infections in allogeneic hematopoietic stem cell transplant recipients: reemergence of Gram-negative rods and increasing antibiotic resistance. Biol Blood Marrow Transplant 2009;15:47-53. https://doi.org/10.1016/j.bbmt.2008.10.024
• 14. Senok A, Dabal LA, Alfaresi M, et al. Clinical impact of the Biofire Blood Culture Identification 2 Panel in adult patients with bloodstream infection: a multicentre observational study in the United Arab Emirates. Diagnostics (Basel) 2023;13:2433. https://doi.org/10.3390/diagnostics13142433
• 15. Fidalgo B, Morata L, Cardozo C, et al. Information delay of significant bloodstream isolates and patient mortality: a retrospective analysis of 6225 adult patients with bloodstream infections. Clin Infect Dis 2023;77:680-686. https://doi.org/10.1093/cid/ciad243
• 16. Zhang Y, La M, Sun J, et al. Diagnostic value and prognostic significance of procalcitonin combined with C-reactive protein in patients with bacterial bloodstream infection. Comput Math Methods Med 2022;2022:6989229. https://doi.org/10.1155/2022/6989229