Open AccessRisk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance
Author(s) -
Carolina García-Vidal,
Celia Cardozo-Espinola,
Pedro PuertaAlcalde,
Francesc Marco,
Adrián Téllez,
Daiana Agüero,
Francisco Romero-Santana,
Marina DíazBeyá,
Eva Giné,
Laura Morata,
Olga RodríguezNúñez,
José Antonio Martínez,
Josep Mensa,
Jordi Esteve,
Álex Soriano
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0199531
Subject(s) - medicine , enterococcus , pseudomonas aeruginosa , bacteremia , antibiotics , septic shock , epidemiology , multiple drug resistance , microbiology and biotechnology , sepsis , biology , bacteria , genetics
Objectives We assess the epidemiology and risk factors for mortality of bloodstream infection (BSI) in patients with acute leukemia (AL). Methods Prospectively collected data of a cohort study from July 2004 to February 2016. Multivariate analyses were performed. Results 589 episodes of BSI were documented in 357 AL patients, 55% caused by gram-positive bacteria (coagulase-negative staphylococci 35.7%, Enterococcus spp 10.8%) and 43.5% by gram-negative bacteria ( E . coli 21%, PA 12%). We identified 110 (18.7%) multidrug-resistant (MDR) microorganisms, especially MDR- Pseudomonas aeruginosa (7%) and extended-spectrum beta-lactamase producing Enterobacteriaceae (7%). The 30-day mortality was 14.8%. Age (OR 3.1; 95% CI 1.7–5.7); chronic lung disease (4.8; 1.1–21.8); fatal prognosis according to McCabe index (13.9; 6.4–30.3); shock (3.8; 1.9–7.7); pulmonary infection (3.6; 1.3–9.9); and MDR-PA infections with inappropriate treatment (12.8; 4.1–40.5) were related to mortality. MDR-PA BSI was associated to prior antipseudomonal cephalosporin use (9.31; 4.38–19.79); current use of betalactams (2.01; 1.01–4.3); shock (2.63; 1.03–6.7) and pulmonary source of infection (9.6; 3.4–27.21). Conclusions MDR organisms were commonly isolated in BSI in AL. Inappropriate empiric antibiotic treatment for MDR-PA is the primary factor related to mortality that can be changed. New treatment strategies to improve the coverage of MDR-PA BSI should be considered in those patients with risk factors for this infection.