Impact of multidrug resistance in cancer patients with bloodstream infections caused by Gram-negative bacilli: results from a multicentre study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Falcone Marco, Carbonara Sergio, Marino Andrea, Di Caprio Giovanni, Carretta Anna, Mularoni Alessandra, Mariani Michele Fabiano, Maraolo Alberto Enrico, Dalfino Lidia, Corbo Lorenzo, Medaglia Alice Annalisa, Sgroi Christian, Del Vecchio Rosa Fontana, Ceccarelli Giancarlo, Albanese Antonio, Buscemi Calogero, Talamanca Simona, Foti Giuseppe, Franco Antonina, Iacobello Carmelo, Corrao Salvatore, Morana Domenico, Pieralli Filippo, Gentile Ivan, Santantonio Teresa, Cascio Antonio, Coppola Nicola, Cacopardo Bruno, Venditti Mario, Menichetti Francesco, Tiseo Giusy
Аннотация
PATIENTS AND METHODS: This was a prospective observational multicentre study including cancer patients with BSI caused by GNB (June 2018-January 2020). The primary outcome was 30-day mortality. The secondary outcome was mortality attributable to MDR organisms, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant (CR) Enterobacterales and CR non-fermenting GNB (CR-NFGNB). A multivariable regression analysis identified factors associated with 30-day mortality. Adjusted odds ratio (aOR) with 95% confidence intervals (95% CI) were calculated. Attributable mortality was estimated according to DRIVE-AB Consortium's formula.
RESULTS: Of 347 cancer patients, 232 (66.9%) had BSI caused by MDR-GNB. Thirty-day mortality was 27.2% in patients with BSI caused by MDR organisms compared to 7% in those with BSI by susceptible GNB (P < 0.001). In the multivariable analysis, MDR-GNB including ESBL-producing Enterobacterales (aOR 8.734, 95% CI 1.411-54.077, P = 0.02), KPC-producing Enterobacterales (aOR 8.548, 95% CI 1.296-56.411, P = 0.026), metallo-β-lactamases (MBL)-producing Enterobacterales (aOR 15.802, 95% CI 1.408-68.667, P = 0.022) and CR-NFGNB (aOR 53.373, 95% CI 5.104-89.146, P < 0.001) as compared to susceptible GNB were independently associated with 30-day mortality. Mortality attributable to MDR-GNB was 43%. According to causative pathogens, attributable mortality was 33% in ESBL, 32% in KPC, 47% in MBL and 73% in CR-NFGNB.
CONCLUSIONS: In cancer patients, BSIs due to MDR-GNB are associated with excess mortality compared to BSI by susceptible GNB. Strategies to reduce the spread of MDR-GNB and to promote optimal management of affected patients are urgently needed.