Mucosal barrier injury as an independent risk factor for laboratory-confirmed bloodstream infection in patients with hematological malignancies: a real-world study.
Hematological malignancy (HM) patients are at high risk of bloodstream infections (BSIs) due to chemotherapy-induced mucosal barrier injury (MBI), invasive procedures, and prolonged antimicrobial exposure. While conventional nosocomial infection paradigms emphasize catheter-related biofilms, emerging evidence highlights the role of disrupted oral/gut microbiomes in bacterial translocation. This study aimed to identify risk factors for bacteremia secondary to MBI following chemotherapy in patients with HM.
A single-center, retrospective analysis of 72 HM patients, including 24 with mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), 22 with non-MBI-LCBI, and 26 controls without BSIs, was conducted. Microbiology profiles, resistance patterns, and risk factors for BSIs were analyzed.
All MBI-LCBI patients had significantly longer neutropenia duration than non-MBI-LCBI patients did (median 6.5 vs. 3.0 days, p = 0.013). Multivariate analysis identified MBI as an independent risk factor for BSIs (OR = 11.467, 95% CI1.287-102.170). Prolonged hospitalization (> 30 days) was associated with BSI occurrence (OR = 6.758, 95% CI 1.102-41.440) and neutropenia duration (OR = 1.112, 95% CI 1.014-1.220). Significant differences in pathogen distribution were observed between groups: Escherichia coli, Klebsiella pneumoniae, and viridans group streptococci predominated in the MBI-LCBI group, whereas Pseudomonas aeruginosa and Staphylococcus spp. were common in the non-MBI-LCBI group. Carbapenem resistance remained below 20% for key gram-negative pathogens.
MBI is an independent risk factor for BSI in HM patients, highlighting the need for targeted mucosal protection strategies. MBI-LCBI pathogens primarily originate from the gut/oral flora, and are distinct from catheter-related infections. Carbapenems are recommended for empirical therapy, yet resistance surveillance remains essential.
A single-center, retrospective analysis of 72 HM patients, including 24 with mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), 22 with non-MBI-LCBI, and 26 controls without BSIs, was conducted. Microbiology profiles, resistance patterns, and risk factors for BSIs were analyzed.
All MBI-LCBI patients had significantly longer neutropenia duration than non-MBI-LCBI patients did (median 6.5 vs. 3.0 days, p = 0.013). Multivariate analysis identified MBI as an independent risk factor for BSIs (OR = 11.467, 95% CI1.287-102.170). Prolonged hospitalization (> 30 days) was associated with BSI occurrence (OR = 6.758, 95% CI 1.102-41.440) and neutropenia duration (OR = 1.112, 95% CI 1.014-1.220). Significant differences in pathogen distribution were observed between groups: Escherichia coli, Klebsiella pneumoniae, and viridans group streptococci predominated in the MBI-LCBI group, whereas Pseudomonas aeruginosa and Staphylococcus spp. were common in the non-MBI-LCBI group. Carbapenem resistance remained below 20% for key gram-negative pathogens.
MBI is an independent risk factor for BSI in HM patients, highlighting the need for targeted mucosal protection strategies. MBI-LCBI pathogens primarily originate from the gut/oral flora, and are distinct from catheter-related infections. Carbapenems are recommended for empirical therapy, yet resistance surveillance remains essential.
Authors
Liu Liu, Jiang Jiang, Pi Pi, Chen Chen, Ren Ren, Dai Dai, Wu Wu, Guo Guo, Zhang Zhang, Xie Xie, Luo Luo
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