Infection and Drug Resistance (Aug 2021)
Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing Enterobacterales in Patients with Neoplasia
Abstract
Tiago da Cunha Ferreira,1– 3 Ianick Souto Martins3,4 1Infection Control Division, Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Infectious Diseases Division, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 3Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil; 4Infection Control Division, Hospital do Câncer I, Instituto Nacional do Câncer, Rio de Janeiro, RJ, BrazilCorrespondence: Ianick Souto MartinsFaculty of Medicine, Universidade Federal Fluminense, Rua Marquês de Paraná, 303, Centro, Niterói, RJ, CEP 240033-900, BrazilTel +55 21 2629-9000Email [email protected]: The infections caused by ESCPM Enterobacterales (Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp. and Morganella spp.) have limited therapeutic options. Patients with neoplastic diseases are particularly vulnerable to bloodstream infections (BSIs).Objective: To analyze determinant factors of death in patients with neoplasia complicated with BSI caused by ESCPM Enterobacterales.Patients and Methods: A cohort study of patients aged 18 years or older with neoplasia and BSI due to ESCPM group was conducted at the Cancer Hospital I of the National Cancer Institute, Brazil, from September 2012 to December 2017. The variables associated with death were analyzed using multivariate logistic regression.Results: Of the 103 patients included in the cohort, 67.0% were male, the median age was 63 years and 67.0% had solid tumors. Of the 107 BSI episodes evaluated, 70.1% were hospital-acquired infections, 54.2% were secondary to extravascular focus of infection, gastrointestinal tract (19.6%), mainly. Enterobacter spp. (n: 49, 45.4%) was the most frequent agent isolated followed by Serratia spp. (n: 34, 31.5%), Morganella morganii (n: 16, 14.9%), Citrobacter freundii. (n: 7, 6.5%) and Providencia spp. (n: 2, 1.8%). Ten (9.3%) BSI episodes were caused by multidrug-resistant ESCPM Enterobacterales (MDR-ESCPM). The 7-day and 30-day mortality were 9.3% and 21.5%, respectively. The BSIs caused by MDR-ESCPM were independently associated with 7-day death (OR = 21.62 95% CI: 1.81– 258.51 P = 0.01). Monotherapy with piperacillin-tazobactam tended to be associated with 7-day death (OR = 10.46 95% CI: 0.97– 112.91 P = 0.05) and 30-day death (OR = 2.73 95% CI: 0.96– 7.70 P = 0.05).Conclusion: BSIs due to ESCPM group have high mortality and when caused by MDR-ESCPM are independently associated with 7-day death. The possible association of piperacillin-tazobactam monotherapy for BSI-ESCPM with death needs to be better studied.Keywords: β-lactamases, mortality, cancer, piperacillin-tazobactam
