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Abstract：
BACKGROUND: Cancer patients are vulnerable to infections due to immunosuppression caused by cancer itself and its treatment. The emergence of antimicrobial-resistant bacteria further complicates the treatment of infections and increases the mortality and hospital stays. This study aimed to investigate the microbial spectrum, antimicrobial resistance patterns, risk factors, and their impact on clinical outcomes in these patients.
METHODS: A prospective study was conducted at a tertiary care cancer hospital in Patna, Bihar, India, which included cancer patients aged 18 years and older with positive microbial cultures.
RESULTS: This study analysed 440 patients, 53% (234) of whom were females, with an average age of 49.27 (± 14.73) years. A total of 541 isolates were identified, among which 48.01% (242) were multidrug resistant (MDR), 29.76% (150) were extensively drug resistant (XDR), and 19.84% (112) were sensitive. This study revealed that patients who underwent surgery, chemotherapy, were hospitalized, had a history of antibiotic exposure, and had severe neutropenia were more susceptible to MDR and XDR infections. The average hospital stays were 16.90 (± 10.23), 18.30 (± 11.14), and 22.83 (± 13.22) days for patients with sensitive, MDR, and XDR infections, respectively. The study also revealed overall 30-day mortality rate of 31.81% (140), whereas the MDR and XDR group exhibited 38.92% and 50.29% rates of 30-day mortality respectively (P < 0.001). Possible risk factors identified that could lead to mortality, were cancer recurrence, sepsis, chemotherapy, indwelling invasive devices such as foley catheter, Central venous catheter and ryles tube, MASCC score (< 21) and pneumonia.
CONCLUSIONS: This study emphasizes the necessity for personalized interventions among cancer patients, such as identifying patients at risk of infection, judicious antibiotic use, infection control measures, and the implementation of antimicrobial stewardship programs to reduce the rate of antimicrobial-resistant infection and associated mortality and hospital length of stay.
METHODS: A prospective study was conducted at a tertiary care cancer hospital in Patna, Bihar, India, which included cancer patients aged 18 years and older with positive microbial cultures.
RESULTS: This study analysed 440 patients, 53% (234) of whom were females, with an average age of 49.27 (± 14.73) years. A total of 541 isolates were identified, among which 48.01% (242) were multidrug resistant (MDR), 29.76% (150) were extensively drug resistant (XDR), and 19.84% (112) were sensitive. This study revealed that patients who underwent surgery, chemotherapy, were hospitalized, had a history of antibiotic exposure, and had severe neutropenia were more susceptible to MDR and XDR infections. The average hospital stays were 16.90 (± 10.23), 18.30 (± 11.14), and 22.83 (± 13.22) days for patients with sensitive, MDR, and XDR infections, respectively. The study also revealed overall 30-day mortality rate of 31.81% (140), whereas the MDR and XDR group exhibited 38.92% and 50.29% rates of 30-day mortality respectively (P < 0.001). Possible risk factors identified that could lead to mortality, were cancer recurrence, sepsis, chemotherapy, indwelling invasive devices such as foley catheter, Central venous catheter and ryles tube, MASCC score (< 21) and pneumonia.
CONCLUSIONS: This study emphasizes the necessity for personalized interventions among cancer patients, such as identifying patients at risk of infection, judicious antibiotic use, infection control measures, and the implementation of antimicrobial stewardship programs to reduce the rate of antimicrobial-resistant infection and associated mortality and hospital length of stay.
摘要：
背景：由于癌症本身及其治疗引起的免疫抑制，癌症患者易受感染。抗微生物抗性细菌的出现进一步使感染的治疗复杂化并增加死亡率和住院时间。本研究旨在调查微生物谱,抗菌素耐药性模式，危险因素，以及它们对这些患者临床结局的影响。
方法：一项前瞻性研究在Patna的三级癌症医院进行，比哈尔邦,印度,其中包括18岁及以上微生物培养阳性的癌症患者。
结果：这项研究分析了440名患者，其中53%（234）是女性，平均年龄49.27(±14.73)岁。共鉴定出541株分离株,其中48.01%(242)为多重耐药(MDR)，29.76%(150)存在广泛耐药(XDR)，敏感率为19.84%(112)。这项研究表明，接受手术的患者，化疗,住院了,有抗生素暴露史,并且有严重的中性粒细胞减少更容易受到MDR和XDR感染。平均住院时间为16.90(±10.23),18.30(±11.14),敏感患者为22.83（±13.22）天，MDR,和XDR感染，分别。该研究还显示，30天的总体死亡率为31.81%(140)，而MDR和XDR组的30天死亡率分别为38.92％和50.29％（P<0.001）。确定可能导致死亡的危险因素，癌症复发，脓毒症,化疗,留置侵入性装置，如Foley导管，中心静脉导管和莱尔管，MASCC评分（<21）和肺炎。
结论：本研究强调对癌症患者进行个性化干预的必要性，例如确定有感染风险的患者，明智的抗生素使用，感染控制措施,以及实施抗菌药物管理计划，以降低抗菌药物耐药感染率和相关死亡率以及住院时间。
方法：一项前瞻性研究在Patna的三级癌症医院进行，比哈尔邦,印度,其中包括18岁及以上微生物培养阳性的癌症患者。
结果：这项研究分析了440名患者，其中53%（234）是女性，平均年龄49.27(±14.73)岁。共鉴定出541株分离株,其中48.01%(242)为多重耐药(MDR)，29.76%(150)存在广泛耐药(XDR)，敏感率为19.84%(112)。这项研究表明，接受手术的患者，化疗,住院了,有抗生素暴露史,并且有严重的中性粒细胞减少更容易受到MDR和XDR感染。平均住院时间为16.90(±10.23),18.30(±11.14),敏感患者为22.83（±13.22）天，MDR,和XDR感染，分别。该研究还显示，30天的总体死亡率为31.81%(140)，而MDR和XDR组的30天死亡率分别为38.92％和50.29％（P<0.001）。确定可能导致死亡的危险因素，癌症复发，脓毒症,化疗,留置侵入性装置，如Foley导管，中心静脉导管和莱尔管，MASCC评分（<21）和肺炎。
结论：本研究强调对癌症患者进行个性化干预的必要性，例如确定有感染风险的患者，明智的抗生素使用，感染控制措施,以及实施抗菌药物管理计划，以降低抗菌药物耐药感染率和相关死亡率以及住院时间。
