Risk Factors of Multidrug-resistant Klebsiella spp. in Hospitalized Cancer Patients in Erbil Governate, Iraq

Cancer is the second leading cause of death in Romania and worldwide. Cancer patients are at increasing risk of acquiring bacterial infection with multi-resistant germs, including multidrug-resistant (MDR) strains of Gram-negative bacteria involved in nosocomial infection. Romania is one of the South-Eastern European countries with one of the highest prevalence rates of MDR pathogens. To determine the resistance pattern of bacterial profile and antibiotic resistance pattern in cancer patients admitted at the County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 90 adult cancer patients admitted from January to December 2018. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analysed 92 samples from 90 oncological patients (37-86 years). A total of 157 bacterial isolates were obtained, of which 37 strains of Staphylococcus aureus (23.56%), followed by Streptococcus pneumoniae (23- 14.64%), Klebsiella spp. and Escherichia coli (22 - 14,01%). The most common isolates were from respiratory tract (86 isolates - 54.77%). High rates of MDR were found for E. coli (63.63%), MRSA (61,11%) and Klebsiella spp. (54,54%), while one third of the isolated strains of Pseudomonas aeruginosa, Acinetobacter spp. and Proteus spp. were MDR. The findings of this study may be the basis for further more extensive studies highlighting the germs involved in the infectious pathology of cancer patients, in order to determine the antimicrobial resistance and to improve the methods of prophylaxis and treatment. Keywords: multidrug resistance (MDR), cancer patients, bacterial pathogen

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Impact of antibiotic resistance on outcomes of neutropenic cancer patients withPseudomonas aeruginosabacteraemia (IRONIC study): study protocol of a retrospective multicentre international study

BMJ Open ◽

10.1136/bmjopen-2018-025744 ◽

2019 ◽

Vol 9 (5) ◽

pp. e025744 ◽

Cited By ~ 2

Author(s):

Adaia Albasanz-Puig ◽

Carlota Gudiol ◽

Rocío Parody ◽

Cristian Tebe ◽

Murat Akova ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Resistance ◽

Cancer Patients ◽

Case Fatality ◽

International Study ◽

Multidrug Resistant ◽

University Hospital ◽

Personal Privacy ◽

Haematological Patients ◽

The Impact

IntroductionPseudomonas aeruginosa(PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality.Methods and analysisThis is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates.Ethics and disseminationThe Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients’ personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications.

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Risk factors for acquisition of multidrug-resistant Acinetobacter baumannii among cancer patients

American Journal of Infection Control ◽

10.1016/j.ajic.2013.04.003 ◽

2013 ◽

Vol 41 (12) ◽

pp. 1249-1252 ◽

Cited By ~ 28

Author(s):

Yuriko Fukuta ◽

Robert R. Muder ◽

Mounzer E. Agha ◽

Lloyd G. Clarke ◽

Marilyn M. Wagener ◽

...

Keyword(s):

Risk Factors ◽

Acinetobacter Baumannii ◽

Cancer Patients ◽

Multidrug Resistant

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Nosocomial Infections Due to Multidrug-Resistant Bacteria in Cancer Patients: A Seven-Year Experience of an Oncology Center in Western China

10.21203/rs.2.23185/v1 ◽

2020 ◽

Author(s):

Ai-Min Jiang ◽

Xin Shi ◽

Na Liu ◽

Huan Gao ◽

Meng-Di Ren ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Cancer Patients ◽

Nosocomial Infections ◽

Multidrug Resistant ◽

Western China ◽

Resistant Bacteria ◽

Klebsiella Pneumonia ◽

Multidrug Resistant Bacteria ◽

Antibiotic Resistant

Abstract Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate characteristics, antibiotic-resistant patterns, and prognosis of nosocomial infections caused by multidrug-resistant bacteria (MDR) in cancer patients. Methods: This retrospectively analyzed cancer patients with MDR bacteria caused nosocomial infections from August 2013 to May 2019 and was conducted to explore the risk factors, clinical features, outcomes, and antibiotic-resistant patterns of these infections. Results: Overall, 257 cancer patients developed nosocomial infections caused by MDR bacteria. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae was the most frequently isolated multidrug-resistant Gram-negative bacteria (MDRGNB), followed by ESBL-producing Klebsiella pneumonia, and Acinetobacter baumannii. Cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, length of hospitalization, hemoglobin, and albumin were independent factors for 30-day mortality in the study population. The isolated MDR bacteria were highly sensitive to amikacin, meropenem, imipenem, tigecycline, and piperacillin/tazobactam. Conclusions: Cancer patients with prolonged hospitalization was an independent predictor of a favorable outcome. However, cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, anemia, and hypoproteinemia were independent risk factors of 30-day mortality.

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Infections Due to Multidrug-Resistant Bacteria in Oncological Patients: Insights from a Five-Year Epidemiological and Clinical Analysis

Microorganisms ◽

10.3390/microorganisms7090277 ◽

2019 ◽

Vol 7 (9) ◽

pp. 277 ◽

Cited By ~ 9

Author(s):

Eleni Isidora A. Perdikouri ◽

Kostoula Arvaniti ◽

Dimitrios Lathyris ◽

Fani Apostolidou Kiouti ◽

Eleni Siskou ◽

...

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Protective Factor ◽

Current Knowledge ◽

Significant Risk ◽

Multidrug Resistant ◽

Adverse Outcomes ◽

Resistant Bacteria ◽

Carbapenem Resistant ◽

Oncological Patients

Bacterial infections are frequent complications in cancer patients. Among them, those caused by multidrug-resistant (MDR) bacteria increase morbidity and mortality mainly because of limited therapeutic options. Current knowledge regarding MDR infections in patients with solid tumors is limited. We assessed the epidemiology and risk factors of increased mortality in these patients. In this retrospective five-year single cohort observational study, we included all oncological patients with MDR infections. Cancer-related parameters, comorbidities, prior use of antibiotics, previous surgical interventions and hospitalization, as well as the use of invasive procedures were investigated as potential risk factors causing adverse outcomes. Seventy-three patients with MDR infection were included: 37% with carbapenem-resistant Klebsiella pneumoniae, 24% with oxacillin-resistant Staphylococcus aureus (MRSA) and 21% with carbapenem-resistant Acinetobacter baumanni. Previous colonization with MDR bacteria was detected in 14% patients, while 20% of the patients presented MDR colonization or infection at ward admission. Mortality during the infection episode was 32%. Duration of hospitalization and CRP were statistically significant risk factors of mortality, whereas administration of guided antibiotics was a protective factor. Knowledge of local epidemiology of MDR bacteria can help physicians promptly identify cancer patients at risk of MDR infections and initiate timely effective empirical antibiotic treatment that can eventually improve the overall therapeutic management.

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Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkq494 ◽

2010 ◽

Vol 66 (3) ◽

pp. 657-663 ◽

Cited By ~ 133

Author(s):

C. Gudiol ◽

F. Tubau ◽

L. Calatayud ◽

C. Garcia-Vidal ◽

M. Cisnal ◽

...

Keyword(s):

Risk Factors ◽

Antibiotic Therapy ◽

Cancer Patients ◽

Multidrug Resistant ◽

Gram Negative

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Risk factors for multidrug-resistant bacteremia in hospitalized cancer patients with febrile neutropenia: A cohort study

American Journal of Infection Control ◽

10.1016/j.ajic.2013.06.025 ◽

2014 ◽

Vol 42 (1) ◽

pp. 74-76 ◽

Cited By ~ 16

Author(s):

Regis G. Rosa ◽

Luciano Z. Goldani ◽

Rodrigo P. dos Santos

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Multidrug Resistant

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Role of Lock Therapy for Long-Term Catheter-Related Infections by Multidrug-Resistant Bacteria

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00569-18 ◽

2018 ◽

Vol 62 (9) ◽

Cited By ~ 3

Author(s):

Maristela P. Freire ◽

Ligia C. Pierrotti ◽

Antonio E. Zerati ◽

Luciana Benites ◽

Joaquim Mauricio da Motta-Leal Filho ◽

...

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Cancer Patients ◽

Sofa Score ◽

Protective Factor ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Lock Therapy ◽

The Impact

ABSTRACT The management of long-term central venous catheter (LTCVC) infections by multidrug-resistant (MDR) bacteria in cancer patient is a challenge. The objectives of this study were to analyze outcomes in cancer patients with LTCVC-associated infection, identify risks for unfavorable outcomes, and determine the impact of MDR bacteria and antibiotic lock therapy (ALT) in managing such infections. We evaluated all LTCVC-associated infections treated between January 2009 and December 2016. Infections were reported in accordance with international guidelines for catheter-related infections. The outcome measures were 30-day mortality and treatment failure. We analyzed risk factors by Cox forward-stepwise regression. We identified 296 LTCVC-associated infections; 212 (71.6%) were classified as bloodstream infections (BSIs). The most common agent was Staphylococcus aureus. Forty-six (21.7%) infections were due to MDR Gram-negative bacteria. ALT was used in 62 (29.2%) patients, with a 75.9% success rate. Risk factors identified for failure of the initial treatment were having a high sequential organ failure assessment (SOFA) score at diagnosis of infection and being in palliative care; introduction of ALT at the start of treatment was identified as a protective factor. Risk factors identified for 30-day mortality after LTCVC-associated infection were a high SOFA score at diagnosis, infection with MDR bacteria, and palliative care; introduction of ALT at the start of treatment, hematological malignancies, and adherence to an institutional protocol for the management of LTCVC-associated infection were identified as protective factors. Despite the high incidence of infection with MDR bacteria, ALT improves the outcome of LTCVC-associated infection in cancer patients.

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