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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
INTRODUCTION
Cancers of the gastrointestinal (GI) tract and its associated excretory glands, also known as digestive cancer, are one of the most common causes of cancer-related death worldwide, and it remains a major public health concern for past decades.1 Although surgery, chemotherapy, radiotherapy, molecular targeted therapy, and immunotherapy have significantly improved the survival of GI cancer patients in recent years, it remains a bleak prognosis. Furthermore, these patients are predisposed to developing nosocomial infections due to immunodeficiency caused by malignancy itself and its treatments.2 Even though most infections are temporary, the consequences can last longer.
Nosocomial infections in cancer patients delay the initiation of chemotherapy and reduce the routine dosage.2,3 In addition, it prolongs hospitalization, raises morbidity and mortality, and increases the financial burden of patients and their families.3–5 Therefore, early identification of infection episodes and swift initiation of appropriate antibiotic treatment is pivotal for cancer patients, and it plays an important role in reducing infection-associated mortality.2 As far as we know, previously published studies have merely focused on bloodstream infections (BSIs) in cancer patients. In fact, except for BSIs, urinary tract infections, respiratory infections, and gastrointestinal tract infections are more common in nosocomial infections.6 Herein, we conducted the present study to extensively describe the microbiological distribution, antibiotic resistance pattern, and clinical outcomes of nosocomial infections in hospitalized GI cancer patients.
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