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Colonization with multi-drug-resistant organisms negatively impacts survival in patients with non-small cell lung
Jan A Stratmann1, Raphael Lacko1, Olivier Ballo1
1Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany.
Objectives:
Multidrug-resistant organisms (MDRO) are considered an emerging threat worldwide. Data covering the clinical impact of MDRO colonization in patients with solid malignancies, however, is widely missing. We sought to determine the impact of MDRO colonization in patients who have been diagnosed with Non-small cell lung cancer (NSCLC) who are at known high-risk for invasive infections.
Materials And Methods:
Patients who were screened for MDRO colonization within a 90-day period after NSCLC diagnosis of all stages were included in this single-center retrospective study.
Results:
Two hundred and ninety-five patients were included of whom 24 patients (8.1%) were screened positive for MDRO colonization (MDROpos) at first diagnosis. Enterobacterales were by far the most frequent MDRO detected with a proportion of 79.2% (19/24). MDRO colonization was present across all disease stages and more present in patients with concomitant diabetes mellitus. Median overall survival was significantly inferior in the MDROpos study group with a median OS of 7.8 months (95% CI, 0.0-19.9 months) compared to a median OS of 23.9 months (95% CI, 17.6-30.1 months) in the MDROneg group in univariate (p = 0.036) and multivariate analysis (P = 0.02). Exploratory analyses suggest a higher rate of non-cancer-related-mortality in MDROpos patients compared to MDROneg patients (p = 0.002) with an increased rate of fatal infections in MDROpos patients (p = 0.0002).
Conclusions:
MDRO colonization is an independent risk factor for inferior OS in patients diagnosed with NSCLC due to a higher rate of fatal infections. Empirical antibiotic treatment approaches should cover formerly detected MDR commensals in cases of (suspected) invasive infections.
Insights
Multidrug-resistant organism colonization in non-small cell lung cancer patients is linked to poorer survival. This colonization increases the risk of fatal infections, impacting overall survival outcomes.
Area of Science:
- Oncology
- Infectious Diseases
- Microbiology
Background:
- Multidrug-resistant organisms (MDRO) pose a growing global health threat.
- Clinical data on the impact of MDRO colonization in solid malignancy patients is limited.
- Non-small cell lung cancer (NSCLC) patients are at high risk for invasive infections.
Purpose of the Study:
- To investigate the clinical impact of MDRO colonization in patients diagnosed with NSCLC.
- To determine if MDRO colonization affects overall survival in NSCLC patients.
Main Methods:
- Retrospective, single-center study including 295 NSCLC patients screened for MDRO colonization within 90 days of diagnosis.
- Analysis of MDRO status, type of MDRO, and correlation with survival outcomes.
Main Results:
- 8.1% of NSCLC patients (24/295) were colonized with MDRO, primarily Enterobacterales.
- MDRO colonization was observed across all NSCLC stages and was more prevalent in patients with diabetes mellitus.
- MDRO-colonized patients had significantly inferior median overall survival (7.8 months vs. 23.9 months) and a higher rate of fatal infections.
Conclusions:
- MDRO colonization is an independent risk factor for reduced overall survival in NSCLC patients.
- Increased fatal infections contribute to the poorer outcomes in colonized NSCLC patients.
- Empirical antibiotic strategies should consider common MDR commensals in suspected infections.
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