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Abstract：
Despite the improved outcomes in patients with hematological malignancies, infections caused by multidrug-resistant organisms (MDROs) pose a new threat to these patients. We retrospectively reviewed the patients with hematological cancer and bacterial bloodstream infections (BSIs) at a tertiary hospital between 2003 and 2022 to assess the impact of MDROs on outcomes. Among 328 BSIs, 81 (24.7%) were caused by MDROs. MDRO rates increased from 10.3% (2003-2007) to 39.7% (2018-2022) (P < 0.001). The 30-day mortality rate was 25.0%, which was significantly higher in MDRO-infected patients than in non-MDRO-infected patients (48.1 vs. 17.4%; P < 0.001). The observed trend was more pronounced in patients with newly diagnosed diseases and relapsed/refractory disease but less prominent in patients in complete remission. Among MDROs, carbapenem-resistant Gram-negative bacteria exhibited the highest mortality, followed by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and extended-spectrum β-lactamase-producing Enterobacteriaceae. Multivariate analysis identified independent risk factors for 30-day mortality as age ≥ 65 years, newly diagnosed disease, relapsed/refractory disease, MDROs, polymicrobial infection, CRP ≥ 20 mg/L, and inappropriate initial antibiotic therapy. In conclusion, MDROs contribute to adverse outcomes in patients with hematological cancer and bacterial BSIs, with effects varying based on the underlying disease status and causative pathogens. Appropriate initial antibiotic therapy may improve patient outcomes.
摘要：
尽管血液系统恶性肿瘤患者的预后有所改善，多药耐药菌(MDROs)引起的感染对这些患者构成了新的威胁.我们回顾性回顾了2003年至2022年在三级医院的血液肿瘤和细菌血流感染（BSIs）患者，以评估MDROs对预后的影响。在328个BSI中，81例（24.7%）由MDROs引起。MDRO率从10.3％（2003-2007年）增加到39.7％（2018-2022年）（P<0.001）。30天死亡率为25.0%,MDRO感染患者明显高于非MDRO感染患者(48.1vs.17.4%;P<0.001)。观察到的趋势在新诊断疾病和复发/难治性疾病的患者中更为明显，但在完全缓解的患者中则不那么明显。在MDRO中，耐碳青霉烯类革兰氏阴性菌的死亡率最高，其次是耐万古霉素肠球菌,耐甲氧西林金黄色葡萄球菌,和产超广谱β-内酰胺酶的肠杆菌科细菌。多因素分析确定30天死亡率的独立危险因素为年龄≥65岁，新诊断的疾病，复发性/难治性疾病，MDRO,多微生物感染，CRP≥20mg/L，和不适当的初始抗生素治疗。总之,MDROs有助于血液系统癌症和细菌BSI患者的不良结局，根据潜在的疾病状态和致病病原体的不同，其影响也不同。适当的初始抗生素治疗可以改善患者的预后。
