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Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel)

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Abstract

Multiresistant bacterial infections are a potentially life-threatening condition in acute leukaemia (AL) patients. We aimed to better define the very recent epidemiology and outcome of bloodstream infections (BSIs) in a real-life setting. We prospectively collected all consecutive febrile/infectious episodes occurring in AL patients admitted to 9 haematology units. In 293 AL patients, 433 BSIs were diagnosed. Gram-positive (GP) bacteria were isolated in 44.8 % BSI and Gram-negative (GN) in 38.3 %, while polymicrobial aetiology- or fungi-related events were identified in 15.7 and 1.1 % of the cases, respectively. GP was observed more frequently in patients not in complete remission (p = 0.04), while GN during consolidation cycles (p = 0.003). Extended spectrum β-lactamase-producing strains accounted for 23.2 % of enterobacteria. They were associated with previous antibiotic exposure, including fluoroquinolones prophylaxis (p = 0.01). Carbapenem-resistant (CR) strains occurred in 9 % of enterobacteria. Among Pseudomonas aeruginosa strains, 21.6 % were multiresistant. Overall 30-day mortality was 8.5 %. CR GN and multiresistant P. aeruginosa BSIs were independent predictors of death (p = 0.002), as well as relapsed/resistant AL (18.3 %; p = 0.0002) and the presence of pulmonary infiltrates (26.6 %; p < 0.001). Although GP still predominate over GN BSI, the percentage of antibiotic resistant GN strains is considerable in AL patients and it is associated with poor prognosis.

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Acknowledgments

We would like to thank Erika Borlenghi (Department of Hematology, Spedali Civili, Brescia) and Nicola Fracchiolla (U.O. Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, Milano) for their helpful suggestions and Claudia Basilico (Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Varese) for collaboration.

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Authors and Affiliations

  1. Department of Hematology, Spedali Civili, 25123, Brescia, Italy

    Chiara Cattaneo, A. Passi, M. Petullà & G. Rossi

  2. Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

    P. Zappasodi & M. Da Vià

  3. Dipartimento di Oncologia e Ematologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy

    V. Mancini, S. Ferrari & A. Nosari

  4. U.O. Oncoematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and University of Milan, Milano, Italy

    C. Annaloro & G. Mometto

  5. San Raffaele Scientific Institute of Milan, Milano, Italy

    F. Pavesi

  6. Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, Italy

    C. Skert

  7. Azienda Ospedaliera Universitaria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

    A. Ferrario

  8. Humanitas Cancer Center, Humanitas Clinical and Research Cancer Center, Rozzano, Milano, Italy

    E. Todisco

  9. Department of Internal Medicine, Division of Hematology, Ospedale Valduce, Como, Italy

    V. Saccà

  10. San Gerardo Hospital, Monza, Italy

    L. Verga

Authors
  1. Chiara Cattaneo
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  2. P. Zappasodi
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  3. V. Mancini
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  4. C. Annaloro
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  5. F. Pavesi
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  6. C. Skert
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  7. A. Ferrario
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  8. E. Todisco
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  9. V. Saccà
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  10. L. Verga
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  11. A. Passi
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  12. M. Da Vià
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  13. S. Ferrari
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  14. G. Mometto
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  15. M. Petullà
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  16. A. Nosari
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  17. G. Rossi
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Corresponding author

Correspondence to Chiara Cattaneo.

Ethics declarations

The study was approved by the ethical committee of each of the participating institution, and informed consent was obtained from all patients. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Funding

None.

Conflict of interest

CA: Pfizer, Gilead, MSD (honoraria). AN: Gilead (advisory board), MSD and Roche (honoraria). GR: Gilead and Boehringer (advisory board).

Additional information

Highlights

• A prospective study for bloodstream infections in acute leukaemia patients

• Gram-positive strains still predominate over Gram-negative BSI

• High frequency of multiresistant strains associated with a worse outcome

• Thirty-day mortality was also associated to relapsed/refractory leukaemia and pneumonia

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Cattaneo, C., Zappasodi, P., Mancini, V. et al. Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel). Ann Hematol 95, 1955–1963 (2016). https://doi.org/10.1007/s00277-016-2815-7

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  • DOI: https://doi.org/10.1007/s00277-016-2815-7

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