Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis
Tóm tắt
The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. 6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.
Tài liệu tham khảo
Alevizakos M, Gaitanidis A, Andreatos N, Arunachalam K, Flokas ME, Mylonakis E. Bloodstream infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients with malignancy: a systematic review and meta-analysis. Int J Antimicrob Agents. 2017a;50(5):657–63.
Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005;18(4):657–86.
Biehl LM, Schmidt-Hieber M, Liss B, Cornely OA, Vehreschild MJ. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients—review of the literature from a clinical perspective. Crit Rev Microbiol. 2016;42(1):1–16.
Alevizakos M, Karanika S, Detsis M, Mylonakis E. Colonisation with extended-spectrum beta-lactamase-producing Enterobacteriaceae and risk for infection among patients with solid or haematological malignancy: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016a;48(6):647–54.
Gudiol C, Aguado JM, Carratala J. Bloodstream infections in patients with solid tumors. Virulence. 2016;7(3):298–308.
Ndir A, Diop A, Ka R, Faye PM, Dia-Badiane NM, Ndoye B, et al. Infections caused by extended-spectrum beta-lactamases producing Enterobacteriaceae: clinical and economic impact in patients hospitalized in 2 teaching hospitals in Dakar. Senegal Antimicrob Resist Infect Control. 2016;5:13.
Alevizakos M, Karanika S, Detsis M, Mylonakis E. Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae and risk for infection among patients with solid or haematological malignancy: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016b;48(6):647–54.
Alevizakos M, Gaitanidis A, Andreatos N, Arunachalam K, Flokas ME, Mylonakis E. Bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a systematic review and meta-analysis. Int J Antimicrob Agents. 2017b;50(5):657–63.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clin Res Ed). 2009;339:b2700.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.
Ha YE, Kang CI, Cha MK, Park SY, Wi YM, Chung DR, et al. Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in patients with cancer. Int J Antimicrob Agents. 2013a;42(5):403–9.
Vardakas KZ, Rafailidis PI, Konstantelias AA, Falagas ME. Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: the study, the patient, the bug or the drug? J Infect. 2013;66(5):401–14.
Trecarichi EM, Tumbarello M, Spanu T, Caira M, Fianchi L, Chiusolo P, et al. Incidence and clinical impact of extended-spectrum-β-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies. J Infect. 2009;58(4):299–307.
Kang CI, Chung DR, Ko KS, Peck KR, Song JH. Risk factors for infection and treatment outcome of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in patients with hematologic malignancy. Ann Hematol. 2012;91(1):115–21.
Wu UI, Chen WC, Yang CS, Wang JL, Hu FC, Chang SC, et al. Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis. IJID. 2012;16(1):e47-52.
Ha YE, Kang CI, Cha MK, Park SY, Wi YM, Chung DR, et al. Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with cancer. Int J Antimicrob Agents. 2013b;42(5):403–9.
Kang CI, Wi YM, Ko KS, Chung DR, Peck KR, Lee NY, et al. Outcomes and risk factors for mortality in community-onset bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli, with a special emphasis on antimicrobial therapy. Scand J Infect Dis. 2013;45(7):519–25.
Kim SH, Kwon JC, Choi SM, Lee DG, Park SH, Choi JH, et al. Escherichia coli and Klebsiella pneumoniae bacteremia in patients with neutropenic fever: factors associated with extended-spectrum beta-lactamase production and its impact on outcome. Ann Hematol. 2013;92(4):533–41.
Bodro M, Gudiol C, Garcia-Vidal C, Tubau F, Contra A, Boix L, et al. Epidemiology, antibiotic therapy and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in cancer patients. Support Care Cancer . 2014;22(3):603–10.
Han SB, Jung SW, Bae EY, Lee JW, Lee DG, Chung NG, et al. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bacteremia in febrile neutropenic children. Microb Drug Resist . 2015;21(2):244–51.
Cattaneo C, Zappasodi P, Mancini V, Annaloro C, Pavesi F, Skert C, et al. Emerging resistant bacteria strains in bloodstream infections of acute leukaemia patients: results of a prospective study by the Rete Ematologica Lombarda (Rel). Ann Hematol. 2016;95(12):1955–63.
Ma J, Li N, Liu Y, Wang C, Liu X, Chen S, et al. Antimicrobial resistance patterns, clinical features, and risk factors for septic shock and death of nosocomial e coli bacteremia in adult patients with hematological disease. Medicine . 2017;96(21):e6959.
Cattaneo C, Di Blasi R, Skert C, Candoni A, Martino B, Di Renzo N, et al. Bloodstream infections in haematological cancer patients colonized by multidrug-resistant bacteria. Ann Hematol. 2018;97(9):1717–26.
Çeken S, İskender G, Gedik H, Duygu F, Mert D, Kaya AH, et al. Risk factors for bloodstream infections due to extended-spectrum β-lactamase producing enterobacteriaceae in cancer patients. J Infect Dev Countries. 2018;12(4):265–72.
Islas-Muñoz B, Volkow-Fernández P, Ibanes-Gutiérrez C, Villamar-Ramírez A, Vilar-Compte D, Cornejo-Juárez P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int J Infect Dis. 2018;71:59–64.
Isendahl J, Giske CG, Tegmark Wisell K, Ternhag A, Nauclér P. Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case–control study. Clin Microbiol Infect. 2019;25(11):1408–14.
Gudiol C, Calatayud L, Garcia-Vidal C, Lora-Tamayo J, Cisnal M, Duarte R, et al. Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome. J Antimicrob Chemother. 2010;65(2):333–41.
Kim SJ, Park KH, Chung JW, Sung H, Choi SH, Choi SH. Prevalence and impact of extended-spectrum β-lactamase production on clinical outcomes in cancer patients with enterobacter species bacteremia. Korean J Intern Med. 2014;29(5):637–46.
Gudiol C, Royo-Cebrecos C, Abdala E, Akova M, Alvarez R, la Maestro-de Calle G, et al. Efficacy of beta-lactam/beta-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum-beta-lactamase-producing Enterobacteriaceae in hematological patients with neutropenia. Antimicrob Agents Chemother. 2017;61(8):e00164-e217.
Namikawa H, Yamada K, Yamairi K, Shibata W, Fujimoto H, Takizawa E, et al. Mortality caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia; a case control study: alert to Enterobacteriaceae strains with high minimum inhibitory concentrations of piperacillin/tazobactam. Diagn Microbiol Infect Dis. 2019;94(3):287–92.
Wang SS, Lee NY, Hsueh PR, Huang WH, Tsui KC, Lee HC, et al. Clinical manifestations and prognostic factors in cancer patients with bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella pneumoniae. J Microbiol Immunol Infect. 2011;44(4):282–8.
Benanti GE, Brown ART, Shigle TL, Tarrand JJ, Bhatti MM, McDaneld PM, et al. Carbapenem versus cefepime or piperacillin-tazobactam for empiric treatment of bacteremia due to extended-spectrum-beta-lactamase-producing escherichia coli in patients with hematologic malignancy. Antimicrob Agents Chemother. 2019. https://doi.org/10.1128/AAC.01813-18.
Zhang Q, Gao HY, Li D, Li Z, Qi SS, Zheng S, et al. Clinical outcome of Escherichia coli bloodstream infection in cancer patients with/without biofilm formation: a single-center retrospective study. IDR. 2019;12:359–71.
Metan G, Demiraslan H, Kaynar LG, Zararsiz G, Alp E, Eser B. Factors influencing the early mortality in haematological malignancy patients with nosocomial Gram negative bacilli bacteraemia: a retrospective analysis of 154 cases. Brazilian J Infect Dis . 2013;17(2):143–9.
Kim YJ, Jung SM, Kang J, Ryoo SM, Sohn CH, Seo DW, et al. Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae infection causing septic shock in cancer patients with chemotherapy-induced febrile neutropenia. Intern Emerg Med. 2019;14(3):433–40.
Pitout JDD, Laupland KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8(3):159–66.
Alevizakos M, Mylonakis E. Colonization and infection with extended-spectrum beta-lactamase producing Enterobacteriaceae in patients with malignancy. Expert Rev Anti Infect Ther. 2017;15(7):653–61.
Schelenz S, Nwaka D, Hunter PR. Longitudinal surveillance of bacteraemia in haematology and oncology patients at a UK cancer centre and the impact of ciprofloxacin use on antimicrobial resistance. J Antimicrob Chemother. 2013;68(6):1431–8.
Satlin MJ, Cohen N, Ma KC, Gedrimaite Z, Soave R, Askin G, et al. Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies. J Infect. 2016;73(4):336–45.
Cornejo-Juarez P, Perez-Jimenez C, Silva-Sanchez J, Velazquez-Acosta C, Gonzalez-Lara F, Reyna-Flores F, et al. Molecular analysis and risk factors for Escherichia coli producing extended-spectrum beta-lactamase bloodstream infection in hematological malignancies. PLoS ONE. 2012;7(4):e35780.
Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother. 2012;67(6):1311–20.
Ben-Chetrit E, Eldaim MA, Bar-Meir M, Dodin M, Katz DE. Associated factors and clinical outcomes of bloodstream infection due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae during febrile neutropenia. Int J Antimicrob Agents. 2019;53(4):423–8.