Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San Fernando No. 22, Col. Sección XVI, Del. Tlalpan, 14000 Mexico City, Mexico.
Int J Infect Dis. 2018 Jun;71:59-64. doi: 10.1016/j.ijid.2018.03.022. Epub 2018 Apr 9.
The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR).
We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI.
4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n=210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality.
Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.
本研究旨在评估癌症合并血流感染（BSI）患者的临床特征和与死亡率相关的危险因素，分析多重耐药菌（MDR）。
我们在 2016 年 8 月至 2017 年 7 月期间在一家癌症转诊中心进行了一项前瞻性观察性研究，其中包括所有 BSI。
4220 名患者进行了血培养检测，其中 496 名患者纳入本研究。患者平均年龄为 48 岁。在 299 名患有实体瘤的患者中，继发性 BSI 和中心静脉相关 BSI（CLABSI）是最常见的类型（分别为 55.9%和 31.8%）。在 197 名血液系统疾病患者中，原发性和黏膜屏障损伤（MBI）BSI 是主要类型（分别为 38.6%）。革兰氏阴性菌是最常见的细菌（72.8%），其中大肠埃希菌（n=210，42.3%）占首位，48%为产超广谱β-内酰胺酶（ESBL），1.8%对碳青霉烯类耐药。第 30 天的死亡率为 22%，但当患者未接受适当的抗菌治疗时，死亡率高达 70%。多变量分析显示，肿瘤疾病的进展或复发、抗菌治疗不当和耐药菌与 30 天死亡率独立相关。
MDR 细菌的出现是全球范围内一个重要的医疗保健问题。患有 BSI 的患者，特别是患有 MDR 细菌的患者，其死亡率风险更高。
