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Beyond neutropenia: 14 years analysis of bloodstream infections in hematological malignancies
Aiah M Khateb1, Ahmed S Barefah2, Osman O Radhwi2
1Department of Clinical Laboratory Sciences, Collage of Applied Medical Science, Taibah University, Madina, Saudi Arabia; Health and Life Research Center, Taibah University, Madinah, Saudi Arabia.
Background:
Bloodstream infections (BSIs) are a major cause of morbidity and mortality in patients with hematological malignancies (HMs).
Methods:
This 14-year retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from 2007 to 2021. It examined the epidemiological profile, microbial spectrum, resistance patterns, and outcomes of BSIs in HM patients. Microbial identification was based on aerobic and anaerobic blood cultures; PCR testing was used requested as needed. Statistical analysis was performed in Excel, including one-way ANOVA, Chi-square, and linear regression.
Results:
Among 2112 HM patients, 296 (14 %) experienced at least one BSI episode. Incidence peaked in 2014, 2016, and 2017, with a subsequent decline possibly reflecting improved infection control. Bacterial infections comprised 90 % of cases (n = 1341), the highest was Gram-negative organisms (n = 745) such as E. coli (n = 86) and Klebsiella pneumoniae (n = 77). Gram-positive pathogens (n = 596) included coagulase-negative Staphylococci (n = 319) and Staphylococcus aureus (n = 75). Fungal infections accounted for 4 % (n = 61), primarily Candida albicans. Resistance was high (21.1 %), particularly in Enterococcus (48.9 %), Acinetobacter (45.8 %), E. coli ESBL (40.3 %), and Klebsiella pneumoniae CRE/ESBL (45 %, 32.5 %). The overall mortality was 85 %, significantly higher for resistant Klebsiella pneumoniae (100 % vs. 88.7 %, p = 0.008) and notably elevated for E. coli ESBL (94.2 % vs. 83.1 %, p = 0.063). Adults had the highest incidence. Combined aerobic (69 %) and anaerobic (31 %) cultures improved diagnostic yield, especially in polymicrobial infections.
