Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis.
BACKGROUND
The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients.


METHODS
PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results.


RESULTS
6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60-3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29-3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54-4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.


CONCLUSIONS
Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.
['Jiang|Ai-Min|AM|', 'Liu|Na|N|', 'Zhao|Rui|R|', 'Zheng|Hao-Ran|HR|', 'Chen|Xue|X|', 'Fan|Chao-Xin|CX|', 'Zhang|Rui|R|', 'Zheng|Xiao-Qiang|XQ|', 'Fu|Xiao|X|', 'Yao|Yu|Y|', 'Tian|Tao|T|']
D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D001426:Bacterial Proteins D004755:Enterobacteriaceae D004756:Enterobacteriaceae Infections D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009369:Neoplasms D011379:Prognosis D018805:Sepsis D001618:beta-Lactamases
Bloodstream infection Malignancy Meta-analysis ESBL-PE Mortality Extended-spectrum β-lactamase