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Antibiotic resistance patterns of multidrug resistant bacteria in acute myeloid leukemia patients during induction
Lazar Trajković1, Mirjana Cvetković1, Mirjana Mitrović1
1Clinic of Hematology, University Clinical Centre of Serbia, Belgrade, Serbia.
Introduction:
The treatment of acute myeloid leukemia (AML) is accompanied by infectious complications, particularly during induction. The surge of multi-drug resistant (MDR) bacteria represents an additional problem for the health care of patients with AML.
Methodology:
A retrospective analysis of infectious complications was performed in 84 patients with AML undergoing induction therapy hospitalized between October 2020 and April 2023 at the Clinic of Hematology, University Clinical Centre of Serbia.
Results:
From 84 patients and 95 bacterial isolates, Enterococcus spp. was the most frequent Gram-positive bacterium (26%), showing a 56% resistance rate to vancomycin, and a 77.3% resistance rate to carbapenems, with a 4.3% resistance rate to linezolid and no resistance to tigecycline detected. The most common Gram-negative bacterium, Klebsiella spp. (28%), was resistant to cephalosporins, carbapenems, fluoroquinolones (88%, 84.6%, and 88.5% respectively), with a sizeable resistance rate to ceftazidime/avibactam and colistin (20% and 36.4% respectively). XDR Klebsiella spp. dominated the isolated strains, being detected in 57.7% of cultures, whereas Enterococcus spp. was identified as MDR or XDR in 40% and 28% respectively. The factors associated with developing MDR infections were ECOG PS > 2 (p = 0.024), sepsis (p = 0.0016), and the presence of two or more infectious syndromes (p = 0.016). Patients with a confirmed MDR bacterial infection had a mortality rate of 36.7%.
Conclusions:
Our work demonstrates that the frequency of infections in this population is high, especially with MDR and XDR strains of Klebsiella spp. and Enterococcus spp., which are accompanied by high rates of early death.
Insights
Infections are common in acute myeloid leukemia (AML) patients during induction therapy. Multi-drug resistant (MDR) and extensively drug-resistant (XDR) Klebsiella spp. and Enterococcus spp. cause high mortality rates.
Area of Science:
- Hematology
- Infectious Diseases
- Microbiology
Background:
- Acute myeloid leukemia (AML) treatment, especially induction therapy, frequently leads to infectious complications.
- The rise of multi-drug resistant (MDR) bacteria poses a significant challenge in managing AML patients.
Purpose of the Study:
- To analyze the patterns and outcomes of infectious complications in AML patients undergoing induction therapy.
- To identify the prevalence and resistance profiles of bacterial isolates, focusing on MDR and extensively drug-resistant (XDR) strains.
Main Methods:
- A retrospective analysis of 84 AML patients hospitalized between October 2020 and April 2023.
- Identification and antimicrobial resistance profiling of 95 bacterial isolates.
Main Results:
- Enterococcus spp. and Klebsiella spp. were the most frequent Gram-positive and Gram-negative bacteria, respectively.
- High resistance rates were observed for vancomycin (56%) in Enterococcus spp. and carbapenems (84.6%) in Klebsiella spp.
- XDR Klebsiella spp. (57.7%) and MDR Enterococcus spp. (40%) were prevalent. Factors associated with MDR infections included poor performance status, sepsis, and multiple infectious syndromes. MDR bacterial infections were linked to a 36.7% mortality rate.
Conclusions:
- Infections are frequent in AML patients, particularly those caused by MDR and XDR Klebsiella spp. and Enterococcus spp.
- These resistant bacterial strains are associated with high early mortality rates in AML patients undergoing induction therapy.
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