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Background <p>Hematological malignancy (HM) patients are at high risk of bloodstream infections (BSIs) due to chemotherapy-induced mucosal barrier injury (MBI), invasive procedures, and prolonged antimicrobial exposure. While conventional nosocomial infection paradigms emphasize catheter-related biofilms, emerging evidence highlights the role of disrupted oral/gut microbiomes in bacterial translocation. This study aimed to identify risk factors for bacteremia secondary to MBI following chemotherapy in patients with HM.</p> Methods <p>A single-center, retrospective analysis of 72 HM patients, including 24 with mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), 22 with non-MBI-LCBI, and 26 controls without BSIs, was conducted. Microbiology profiles, resistance patterns, and risk factors for BSIs were analyzed.</p> Results <p>All MBI-LCBI patients had significantly longer neutropenia duration than non-MBI-LCBI patients did (median 6.5 vs. 3.0&#xa0;days, <i>p</i> = 0.013). Multivariate analysis identified MBI as an independent risk factor for BSIs (OR = 11.467, 95% CI1.287–102.170). Prolonged hospitalization (&gt; 30&#xa0;days) was associated with BSI occurrence (OR = 6.758, 95% CI 1.102–41.440) and neutropenia duration (OR = 1.112, 95% CI 1.014–1.220). Significant differences in pathogen distribution were observed between groups: <i>Escherichia coli, Klebsiella pneumoniae</i>, and <i>viridans group streptococci</i> predominated in the MBI-LCBI group, whereas <i>Pseudomonas aeruginosa</i> and <i>Staphylococcus</i> spp. were common in the non-MBI-LCBI group. Carbapenem resistance remained below 20% for key gram-negative pathogens.</p> Conclusions <p>MBI is an independent risk factor for BSI in HM patients, highlighting the need for targeted mucosal protection strategies. MBI-LCBI pathogens primarily originate from the gut/oral flora, and are distinct from catheter-related infections. Carbapenems are recommended for empirical therapy, yet resistance surveillance remains essential.</p>

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Mucosal barrier injury as an independent risk factor for laboratory-confirmed bloodstream infection in patients with hematological malignancies: a real-world study

  • 期刊论文

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  • 发表日期：

    2025年7月21日

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  • Mengna Liu,
  • Xi Jiang,
  • Yingqi Pi,
  • Mingming Chen,
  • Xiuqin Ren,
  • Xinlu Dai,
  • Yixian Wu,
  • Yanrong Guo,
  • Xinyi Zhang,
  • Xiaoying Xie,
  • Zhaofan Luo

摘要

Background

Hematological malignancy (HM) patients are at high risk of bloodstream infections (BSIs) due to chemotherapy-induced mucosal barrier injury (MBI), invasive procedures, and prolonged antimicrobial exposure. While conventional nosocomial infection paradigms emphasize catheter-related biofilms, emerging evidence highlights the role of disrupted oral/gut microbiomes in bacterial translocation. This study aimed to identify risk factors for bacteremia secondary to MBI following chemotherapy in patients with HM.

Methods

A single-center, retrospective analysis of 72 HM patients, including 24 with mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), 22 with non-MBI-LCBI, and 26 controls without BSIs, was conducted. Microbiology profiles, resistance patterns, and risk factors for BSIs were analyzed.

Results

All MBI-LCBI patients had significantly longer neutropenia duration than non-MBI-LCBI patients did (median 6.5 vs. 3.0 days, p = 0.013). Multivariate analysis identified MBI as an independent risk factor for BSIs (OR = 11.467, 95% CI1.287–102.170). Prolonged hospitalization (> 30 days) was associated with BSI occurrence (OR = 6.758, 95% CI 1.102–41.440) and neutropenia duration (OR = 1.112, 95% CI 1.014–1.220). Significant differences in pathogen distribution were observed between groups: Escherichia coli, Klebsiella pneumoniae, and viridans group streptococci predominated in the MBI-LCBI group, whereas Pseudomonas aeruginosa and Staphylococcus spp. were common in the non-MBI-LCBI group. Carbapenem resistance remained below 20% for key gram-negative pathogens.

Conclusions

MBI is an independent risk factor for BSI in HM patients, highlighting the need for targeted mucosal protection strategies. MBI-LCBI pathogens primarily originate from the gut/oral flora, and are distinct from catheter-related infections. Carbapenems are recommended for empirical therapy, yet resistance surveillance remains essential.