Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
J Infect Dev Ctries. 2024 Aug 31;18(8):1185-1195. doi: 10.3855/jidc.19731.
Within the context of the coronavirus disease 2019 (COVID-19) pandemic, this study investigated the multifaceted challenges of bacterial infections in cancer patients with COVID-19. It focuses on clinical predictors, resistance patterns, and microbiological characteristics.
Over 18 months, 112 adult cancer patients with coronavirus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. Bloodstream and respiratory samples were evaluated for bacterial infection using the Phoenix automation system for definitive species identification. In vitro susceptibility testing followed the Clinical Laboratory Standards Institute (CLSI) M100-Ed30 guidelines.
Bacterial infections affected 25.0% of patients, encompassing bacteremia (21.4%) and respiratory tract infections (8.0%). Multivariable analysis identified hypertension, age < 60, and critical COVID-19 as significant predictors for bacterial infections (p-values = 0.024, 0.029, and 0.039, respectively). Most patients received antimicrobial therapy (93.8%), including last-resort carbapenems (52.7%) and colistin (8.9%). Thirty-three bacterial isolates were identified, with secondary infections doubling co-infection rates. Escherichia coli, Klebsiella species, and Staphylococcus aureus were the most common co-infecting species, while Klebsiella, Acinetobacter, and Pseudomonas species were more frequently associated with secondary infections. Alarmingly, 84.8% of isolates displayed high resistance patterns. All isolated S. aureus species were methicillin-resistant, and 62.5% of Gram-negative bacteria were exclusively sensitive to colistin.
The dominance of highly transmissible hospital-acquired bacterial species, with increased resistance and extensive antibiotic use in COVID-19 patients, necessitates strict infection control and antimicrobial stewardship. Developing customized antimicrobial strategies for cancer patients with COVID-19 is crucial to managing bacterial infections effectively and improving patient outcomes.
在 2019 年冠状病毒病（COVID-19）大流行背景下，本研究调查了 COVID-19 癌症患者中细菌感染的多方面挑战。它侧重于临床预测因素、耐药模式和微生物学特征。
在 18 个月的时间里，共纳入了 112 名经逆转录聚合酶链反应（RT-PCR）确诊的冠状病毒感染的成年癌症患者。使用 Phoenix 自动化系统对血流和呼吸道样本进行细菌感染评估，以明确物种鉴定。体外药敏试验遵循临床实验室标准化协会（CLSI）M100-Ed30 指南。
细菌感染影响了 25.0%的患者，包括菌血症（21.4%）和呼吸道感染（8.0%）。多变量分析确定高血压、年龄<60 岁和危重症 COVID-19 是细菌感染的显著预测因素（p 值分别为 0.024、0.029 和 0.039）。大多数患者接受了抗菌治疗（93.8%），包括最后一线的碳青霉烯类（52.7%）和黏菌素（8.9%）。鉴定了 33 株细菌分离株，二次感染使合并感染率翻了一番。大肠埃希菌、克雷伯菌属和金黄色葡萄球菌是最常见的合并感染物种，而克雷伯菌属、不动杆菌属和假单胞菌属与二次感染的关系更密切。令人震惊的是，84.8%的分离株显示出高耐药模式。所有分离的金黄色葡萄球菌均为耐甲氧西林金黄色葡萄球菌，62.5%的革兰氏阴性菌仅对黏菌素敏感。
具有高传染性的医院获得性细菌物种占主导地位，COVID-19 患者的耐药性增加且广泛使用抗生素，这需要严格的感染控制和抗菌药物管理。为 COVID-19 癌症患者制定定制的抗菌策略对于有效管理细菌感染和改善患者预后至关重要。
