Clinical characteristics and risk factor analysis of multidrug-resistant bacterial bloodstream infections in adult acute leukemia patients.

BACKGROUND

Bloodstream infection (BSI) is a common complication in adults with acute leukemia (AL), and the problem of multidrug-resistant (MDR) bacterial infection is exacerbated by inappropriate antibiotic use; therefore, identifying its clinical features and risk factors is critical to improving clinical outcomes.

METHODS

LASSO regression was employed for variable selection, followed by multivariate logistic regression to identify independent risk factors for multidrug-resistant bacterial bloodstream infection. Given the limited number of 30-day mortality events, LASSO regression combined with univariate logistic regression was used to preliminarily explore factors associated with 30-day mortality. Internal validation was performed using the bootstrap method with 1,000 resamples.

RESULTS

The median age of the patients was 56 years. The 30-day all-cause mortality rate was 10.5%. Gram-negative bacteria accounted for 71.053% of the infections, with Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) being most common. Among the 105 identified MDR isolates (55.263%), both Gram-negative and Gram-positive bacteria exhibited high resistance rates to fluoroquinolones and penicillins. Invasive procedures and hypoproteinemia were identified as independent risk factors for MDR bacterial infection. Septic shock, CRP, and the AST/ALT ratio may be associated with an increased risk of 30-day mortality, whereas length of hospitalization may serve as a protective factor. Given the limited number of events, the study may have been underpowered to detect a definitive survival impact of MDR infection, warranting validation in larger cohorts.

CONCLUSION

This study provides important epidemiological data on blood infections in patients with AL in northeastern China, and provides a reference basis for optimizing infection prevention and control strategies based on local pathogens.