Epidemiology, resistant pathogens, and causes of early death in cases of bloodstream infection in patients with hematological malignancies from 2012-2019

Purpose:To investigate the epidemiology,causative pathogen antibiotic susceptibility,and mortality risk factors of bloodstream infection(BSI)in patients with hematological malignancies(HMs).Methods:Single-center retrospective analysis of BSI cases in patients with HMs in a Chinese tertiary hospital from 2012-2019.Results:Among 17,796 analyzed admissions,508 BSI episodes(2.9%;95%confidence interval:2.6%-3.2%)were identified.Of 522 resulting isolates,326(62.5%)were Gram-negative,173(33.1%)were Gram-positive.The BSI incidence among patients with different HMs(severe aplastic anemia:6.7%;acute leukemia:6.2%;myelodysplastic syndrome:3.2%;multiple myeloma:1.3%;and lymphoma:1.0%)differed significantly(p<0.001).The BSI incidence was significantly higher in the hematopoietic stem cell transplantation(HSCT)group(10.2%)than in the non-HSCT group(2.5%;p<0.001).Escherichia coli(30.7%,160/522)was the most common pathogen,followed by Coagulase-negative staphylococci(19.4%,101/522)and Klebsiella pneumoniae(10.0%,52/522).,The rates of imipenem resistance for E.coli,K.pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii were 6.4%,15.0%,27.8%,and 79.0%,respectively.All the Gram-positive pathogens were linezolid susceptible.Three vancomycin-resistant Enterococcus species were isolated.The overall 14-day mortality was 9.8%(95%confidence interval:7.2%-12.4%).A multivariate analysis showed that HM subtype severe aplastic anemia,A.baumannii,and malignancy non-remission were independent 14-day mortality risk factors.Conclusions:Gram-negative bacteria were the most common pathogens,with E.coli as the predominant strain,causing BSIs in HM patients.A carbapenem-resistant A.baumanni with a high mortality rate in HM patients made empirical antimicrobial choice a highly challenging issue.

Epidemiological characteristics of ventilator-associated pneumonia in neurosurgery:A 10-year surveillance study in a Chinese tertiary hospital

Background Ventilator-associated pneumonia(VAP)is a significant and common health concern.The epidemiological landscape of VAP is poorly understood in neurosurgery patients.This study aimed to explore the epidemiology of VAP in this population and devise targeted surveillance,treatment,and control efforts.Methods A 10-year retrospective study spanning 2011 to 2020 was performed in a large Chinese tertiary hospital.Surveillance data was collected from neurosurgical patients and analyzed to map the demographic and clinical characteristics of VAP and describe the distribution and antimicrobial resistance profile of leading pathogens.Risk factors associated with the presence of VAP were explored using boosted regression tree(BRT)models.Results Three hundred ten VAP patients were identified.The 10-year incidence of VAP was 16.21 per 1000 ventilation days.All-cause mortality was 6.1%.The prevalence of gram-negative bacteria,fungi,and gram-positive bacteria among the 357 organisms isolated from VAP patients was 86.0%,7.6%,and 6.4%,respectively;most were multidrug-resistant organisms.Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa were the most common pathogens.The prevalence of carbapenem-resistant A.baumannii,P.aeruginosa,and K.pneumoniae was high and increased over time in the study period.The BRT models revealed that VAP was associated with number of days of ventilator use(relative contribution,47.84±7.25),Glasgow Coma Scale score(relative contribution,24.72±5.67),and tracheotomy(relative contribution,21.50±2.69).Conclusions Our findings provide a better understanding of the epidemiology of VAP and its risk factors in neurosurgery patients.