Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to
C Gudiol1,2,3, A Albasanz-Puig4,3, J Laporte-Amargós4
1Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Barcelona, Spain cgudiol@iconcologia.net jcarratala@bellvitgehospital.cat.
Abstract:
We aimed to assess the rate and predictive factors of bloodstream infection (BSI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa in neutropenic cancer patients. We performed a multicenter, retrospective cohort study including oncohematological neutropenic patients with BSI due to P. aeruginosa conducted across 34 centers in 12 countries from January 2006 to May 2018. A mixed logistic regression model was used to estimate a model to predict the multidrug resistance of the causative pathogens. Of a total of 1,217 episodes of BSI due to P. aeruginosa, 309 episodes (25.4%) were caused by MDR strains. The rate of multidrug resistance increased significantly over the study period (P = 0.033). Predictors of MDR P. aeruginosa BSI were prior therapy with piperacillin-tazobactam (odds ratio [OR], 3.48; 95% confidence interval [CI], 2.29 to 5.30), prior antipseudomonal carbapenem use (OR, 2.53; 95% CI, 1.65 to 3.87), fluoroquinolone prophylaxis (OR, 2.99; 95% CI, 1.92 to 4.64), underlying hematological disease (OR, 2.09; 95% CI, 1.26 to 3.44), and the presence of a urinary catheter (OR, 2.54; 95% CI, 1.65 to 3.91), whereas older age (OR, 0.98; 95% CI, 0.97 to 0.99) was found to be protective. Our prediction model achieves good discrimination and calibration, thereby identifying neutropenic patients at higher risk of BSI due to MDR P. aeruginosa The application of this model using a web-based calculator may be a simple strategy to identify high-risk patients who may benefit from the early administration of broad-spectrum antibiotic coverage against MDR strains according to the local susceptibility patterns, thus avoiding the use of broad-spectrum antibiotics in patients at a low risk of resistance development.
Insights
Multidrug-resistant Pseudomonas aeruginosa bloodstream infections (BSIs) are increasing in neutropenic cancer patients. Prior antibiotic exposure and urinary catheter use predict these infections, aiding early targeted treatment.
Area of Science:
- Infectious Diseases
- Oncology
- Clinical Microbiology
Background:
- Neutropenic cancer patients are highly susceptible to bloodstream infections (BSIs).
- Multidrug-resistant (MDR) Pseudomonas aeruginosa poses a significant threat in immunocompromised populations.
- Understanding risk factors for MDR P. aeruginosa BSIs is crucial for effective management.
Purpose of the Study:
- To determine the incidence of MDR P. aeruginosa BSIs in neutropenic cancer patients.
- To identify predictors of MDR P. aeruginosa BSIs.
- To develop a model for predicting high-risk patients.
Main Methods:
- Multicenter, retrospective cohort study.
- Inclusion of oncohematological neutropenic patients with P. aeruginosa BSI across 34 centers in 12 countries (2006-2018).
- Mixed logistic regression analysis to identify predictive factors for MDR.
Main Results:
- 25.4% of P. aeruginosa BSIs were caused by MDR strains.
- MDR rates significantly increased over the study period.
- Predictors of MDR P. aeruginosa BSI included prior piperacillin-tazobactam, carbapenem use, fluoroquinolone prophylaxis, hematological disease, and urinary catheter. Older age was protective.
Conclusions:
- A predictive model for MDR P. aeruginosa BSI in neutropenic patients was developed.
- The model demonstrates good discrimination and calibration.
- Early identification of high-risk patients can guide targeted antibiotic therapy and optimize resource utilization.
