Multidrug resistance and recurrence in urinary bacteraemia among cancer patients

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BACKGROUND: Urinary tract infections (UTI) in oncological patients can lead to bacteraemia (bUTI), increasing morbidity and mortality. This study assessed the characteristics, outcomes and recurrence of bUTI in oncological patients. METHODS: A retrospective cohort study was conducted at Hospital Clinic, Barcelona, from 2008 to 2019. All episodes of bUTI in oncological patients were analysed. Multivariable regression models identified independent risk factors for multidrug-resistant (MDR) Gram-negative bacilli (GNB), recurrent bUTI and related mortality. RESULTS: A total of 561 bUTI episodes were identified in 478 oncological patients. Urinary tract involvement due to neoplasm was present in 62.2%, and 59.4% had urinary tract instrumentation. Prior UTI-related admission without bacteraemia was reported in 63.8%. Following bUTI, oncological treatment was delayed in 47% and stopped in 33.6% of cases. GNB caused 87.3% of episodes, with Escherichia coli and Klebsiella spp. being the most common pathogens. Enterococcus spp. and Pseudomonas aeruginosa were frequent, particularly in patients with urinary instrumentation. MDR-GNB caused 19.6% of episodes, and 23.4% of cases received inappropriate empirical antibiotic therapy (IEAT). Recurrent bUTI occurred in 14.0% of patients. A simple predictive score efficiently identified patients at high risk of recurrence. Thirty-day mortality was 15.3%, and bUTI-related mortality was 10.7%, with absence of fever, septic shock and carbapenemase-producing Enterobacterales linked to higher related mortality. CONCLUSION: bUTI in oncological patients is predominantly caused by GNB, with high rates of MDR isolates and high mortality. IEAT is common, and recurrence is significant, highlighting the need for targeted preventive strategies and optimized empirical therapy.

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