Risk factors and outcomes of bloodstream infection with multidrug-resistant bacteria in adult patients with acute leukemia.

[BACKGROUND] Bloodstream infection(BSI) caused by multidrug-resistant(MDR) strains is associated with high mortality rates. Notably, there remains a lack of research data addressing the resistance profiles, risk factors, and clinical outcomes of multidrug-resistant bacterial bloodstream infection(MDR-BSI) in acute leukemia(AL) patients. This study aims to analyze mortality, risk factors for death, and causative bacterial characteristics in AL patients with MDR-BSI.

[METHODS] This study retrospectively analyzed data from patients hospitalized at a tertiary hospital in China between January 2020 and December 2024, diagnosed with AL and concurrent MDR-BSI. Bacterial distribution was summarized. Kaplan-Meier survival curves and Logistic regression analysis were employed to assess 30-day mortality and identify risk factors for death following MDR-BSI onset.

[RESULTS] 152 patients were enrolled, yielding 152 MDR bacteria isolates. Gram-negative bacteria(GNB) predominate in MDR-BSI. The overall 30-day mortality rate for MDR-BSI patients was 23.0 %, while the mortality rate specifically for carbapenem-resistant Enterobacteriaceae(CRE) BSI patients was significantly higher at 42.9 %. Univariate analysis identified the following factors associated with 30-day mortality: male sex, smoking history, CRE colonization, Intensive Care Unit(ICU)admission, inappropriate antibiotic therapy, septic shock, relapsed/refractory disease status, pulmonary infection, prior carbapenem use, hypoalbuminemia, and elevated procalcitonin(PCT) levels. Multivariate analysis subsequently demonstrated that CRE colonization(OR=5.938,95 %CI:1.547-22.790,p =0.009), Smoking history(OR=6.532,95 %CI:1.658-25.729,p = 0.007), and Septic shock(OR=50.599, 95 %CI:14.670-174.525, p ＜0.001) were independent risk factors for mortality in MDR-BSI patients.

[CONCLUSIONS] Adult AL patients with MDR-BSI face elevated mortality, where smoking, CRE colonization, and septic shock constitute critical risk factors; consequently, Smoking cessation counseling, screening for intestinal CRE colonization, early recognition of septic shock, and judicious antibiotic therapy may significantly reduce 30-day Mortality in AL Patients with MDR-BSI.