Current epidemiology of microbiologically documented infections and risk factors for multidrug resistance in hematologic patients presenting to the emergency department with suspected bacteremia
Olivier Peyrony1,2, Nicole García-Pouton1,3, Mariana Chumbita1,3, Tommaso Francesco Aiello1,3, Patricia Monzó-Gallo1,3, Christian Teijon-Lumbreras1,3, Antonio Gallardo-Pizarro1,3, Ana Martínez-Urrea1,3, Maria Queralt Salas4, Cristina Pitart5, Gemma Martínez-Nadal6, Laura Rosiñol4, Josep Mensa1,3, Alex Soriano1,3,7, Carolina García-Vidal1,3
Affiliation of the authors
1Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, Spain. 2Servicio de Urgencias, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, París, France. 3IDIBAPS, Universidad de Barcelona, Barcelona, Spain. 4Servicio de Hematología, Hospital Clínic de Barcelona, Barcelona, Spain. 5Servicio de Microbiología, Hospital Clínic de Barcelona, Barcelona, Spain. 6Servicio de Urgencias, Hospital Clínic de Barcelona, Barcelona, Spain. 7CIBERINF, CIBER de Enfermedades Infecciosas, Spain.
Peyrony O, García-Pouton N, Chumbita M, Aiello TF, Monzó-Gallo P, Teijon-Lumbreras C, et al. Current epidemiology of microbiologically documented infections and risk factors for multidrug resistance in hematologic patients presenting to the emergency department with suspected bacteremia. Emergencias. 2025;37:274-80
Summary
Objectives.
To describe the microbiological isolates obtained from hematologic patients seen in the emergency department (ED) who had blood cultures requested and identify the risk factors associated with the isolation of multidrug-resistant bacteria (MDR).
Methods.
We conducted a retrospective, observational, and descriptive study of all consecutive patients with hematologic malignancies who presented to the ED and had, at least, 1 blood culture requested within the first 72 hours following admission from January 2020 through March 2022. The decision on the number of blood cultures and other requested samples was made by the attending physician. A descriptive analysis was performed on the microbiological isolates from blood cultures and, when applicable, from other requested samples. A multivariate analysis was conducted to determine the variables associated with MDR isolation.
Results.
A total of 679 ED visits were included. The median patient age was 66 years (IQR, 52-76), with lymphoma being the most prevalent hematologic disease (35.6%). A significant proportion of patients had prior hospitalizations (47%), were colonized by multidrug-resistant gram-negative bacilli (MDR-GNB) (14%), and/or were neutropenic (27%). In addition to blood cultures, at least, 1 more culture was requested in 556 visits, 202 of which had > 1 blood culture, resulting in a total of 1,751 microbiological cultures in the ED. Most samples came from blood (936; 53.5%), followed by urine (567; 32.4%), respiratory tract (88; 5%), and stool (88; 5%). A total of 211 (12.1%) cultures tested positive in 179 ED visits (26.4%). Of these, 99 (10.6%) blood cultures tested positive in 88 (13%) visits. Among patients with bacteremia, gram-negative bacilli (GNB) were the most common microorganisms (48%), with 12 (25%) categorized as MDR-GNB. Gram-positive microorganisms were documented in 47 (47%) episodes of bacteremia. MDR bacteria were isolated in 40 (5.9%) visits. A past medical history of MDR was associated with MDR isolation in the ED [OR, 4.13; 95%CI, 1.99-8.50].
Conclusions.
The proportion of positive cultures and MDR isolates is relatively high in patients with hematologic malignancies presenting to the ED. A past medical history of MDR is an independent risk factor for MDR isolation.
