Risk factors for and clinical outcomes of carbapenem non-susceptible gram negative bacilli bacteremia in patients with acute myelogenous leukemia

BMC Infect Dis. 2020 Jun 9;20(1):404. doi: 10.1186/s12879-020-05131-2.


Background: Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy.

Methods: We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital.

Results: Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3-284.1; P < 0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4-112.5; P = 0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1-1.2; P < 0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0-14.8; P < 0.001).

Conslusion: Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.

Keywords: Acute myelogenous leukemia; Bacteremia; Carbapenem non-susceptible; Gram negative bacilli; Risk factors.

MeSH terms

  • Acinetobacter baumannii / drug effects
  • Acinetobacter baumannii / isolation & purification
  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Antineoplastic Agents / therapeutic use
  • Carbapenems / pharmacology
  • Case-Control Studies
  • Drug Resistance, Bacterial*
  • Female
  • Gram-Negative Bacterial Infections / complications
  • Gram-Negative Bacterial Infections / diagnosis*
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / mortality
  • Hospital Mortality
  • Humans
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / drug therapy
  • Leukemia, Myeloid, Acute / pathology*
  • Male
  • Middle Aged
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Antineoplastic Agents
  • Carbapenems