Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in...

Area of Science:

• Infectious Diseases
• Oncology
• Clinical Microbiology

Background:

• Biliary-source bloodstream infections (bBSIs) pose significant challenges in oncology patients.
• Understanding the characteristics and risk factors for bBSIs in this population is crucial for effective management.

Purpose of the Study:

• To characterize the clinical and microbiological features of bBSIs in patients with malignancies.
• To identify independent risk factors for bBSI recurrence and mortality.
• To externally validate a previously established recurrence risk score.

Main Methods:

• Retrospective review of 199 bBSI episodes in 136 patients with active solid tumors (2021-2025).
• Analysis of pathogens, multidrug-resistant organism (MDR) prevalence, and inappropriate empirical antibiotic treatment (IEAT).
• Identification of independent risk factors for recurrence and mortality using statistical analysis; external validation of a recurrence risk score.

Main Results:

• The most common cancers were pancreatic (36.7%) and biliary tract (33.2%), with 60.8% having metastatic disease.
• Key pathogens included *Escherichia coli* (43.2%) and *Klebsiella pneumoniae* (24.1%); 19.1% of infections involved MDR organisms.
• Recurrence occurred in 35.7% of patients, associated with biliary tract cancer, prior MDR isolation, and hospitalization. IEAT (37.2%) and metastatic disease were linked to higher 30-day mortality (24.6%).

Conclusions:

• bBSIs in oncology patients are characterized by high rates of MDR pathogens, IEAT, recurrence, and mortality.
• A validated clinical score effectively identifies patients at high risk for bBSI recurrence.
• These findings can inform preventive strategies and clinical management for bBSIs in cancer patients.