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Nosocomial Infections in Gastrointestinal Cancer Patients: Bacterial Profile, Antibiotic Resistance Pattern, and Prognostic Factors

Authors Jiang AM, Liu N, Ali Said R, Ren MD, Gao H, Zheng XQ, Fu X, Liang X, Ruan ZP, Yao Y, Tian T

Received 18 April 2020

Accepted for publication 30 May 2020

Published 25 June 2020 Volume 2020:12 Pages 4969—4979

DOI https://doi.org/10.2147/CMAR.S258774

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eileen O'Reilly


Ai-Min Jiang,1 Na Liu,1 Rim Ali Said,2 Meng-Di Ren,1 Huan Gao,1 Xiao-Qiang Zheng,1 Xiao Fu,1 Xuan Liang,1 Zhi-Ping Ruan,1 Yu Yao,1 Tao Tian1

1Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, People’s Republic of China; 2Department of Imaging and Nuclear Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, People’s Republic of China

Correspondence: Tao Tian; Yu Yao
Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an, Shaanxi 710061, People’s Republic of China
Tel +86-29-85324600
Fax +86-29-85324086
Email tiantao0607@163.com; 13572101611@163.com

Background: Cancers of the gastrointestinal (GI) tract and its associated excretory glands are one of the most common causes of cancer-related death worldwide, and these patients are more likely to developing nosocomial infections due to immunodeficiency.
Objective: To explore the bacterial profile, antibiotic resistance pattern, and prognostic factors of nosocomial infections in hospitalized GI cancer patients.
Methods: All electronic medical records of nosocomial infection episodes in hospitalized GI cancer patients were retrospectively reviewed. In-hospital mortality was used to evaluate the prognosis of patients. Mann–Whitney test, Chi-square test, and binary logistic regression analysis were used to identify potential risk factors for in-hospital mortality. P-values < 0.05 were considered statistically significant.
Results: A total of 428 GI cancer patients developed nosocomial infections during hospitalization. Respiratory tract infections (44.2%), bloodstream infections (BSIs) (11.7%), and abdominal cavity infections (11.4%) were the most common infection sites. The predominant causative pathogens were extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (13.6%), ESBL-negative E. coli (11.9%), and Klebsiella pneumoniae (10.0%). Multidrug-resistant (MDR) strains were detected in 27.6% of isolates. Antimicrobial susceptibility analysis showed that the isolated Gram-negative bacteria (GNB) exhibited high sensitivity to amikacin, meropenem, imipenem, and piperacillin/tazobactam, while the isolated Gram-positive bacteria exhibited high sensitivity to tigecycline, linezolid, and vancomycin. The overall in-hospital mortality of all patients was 11.2% in the study. Multivariate analysis showed that ECOG performance status ≥two scores, length of antibiotic treatment < 9.0 days, existence of septic shock, and hypoproteinemia were independent risk factors for in-hospital mortality.
Conclusion: The burden of nosocomial infections in GI cancer patients is considerably high, with GNB being predominantly isolated causative pathogens. Surveillance on serum albumin level, adequate antibiotic treatment, early identification, and prompt treatment of septic shock could benefit the prognosis.

Keywords: nosocomial infections, gastrointestinal cancer, bacterial profile, antibiotic resistance, prognostic factors

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