Beyond neutropenia: 14 years analysis of bloodstream infections in hematological malignancies

Among 2112 HM patients, 296 (14 %) experienced at least one BSI episode. Incidence peaked in 2014, 2016, and 2017, with a subsequent decline possibly reflecting improved infection control. Bacterial infections comprised 90 % of cases (n = 1341), the highest was Gram-negative organisms (n = 745) such as E. coli (n = 86) and Klebsiella pneumoniae (n = 77). Gram-positive pathogens (n = 596) included coagulase-negative Staphylococci (n = 319) and Staphylococcus aureus (n = 75). Fungal infections accounted for 4 % (n = 61), primarily Candida albicans. Resistance was high (21.1 %), particularly in Enterococcus (48.9 %), Acinetobacter (45.8 %), E. coli ESBL (40.3 %), and Klebsiella pneumoniae CRE/ESBL (45 %, 32.5 %). The overall mortality was 85 %, significantly higher for resistant Klebsiella pneumoniae (100 % vs. 88.7 %, p = 0.008) and notably elevated for E. coli ESBL (94.2 % vs. 83.1 %, p = 0.063). Adults had the highest incidence. Combined aerobic (69 %) and anaerobic (31 %) cultures improved diagnostic yield, especially in polymicrobial infections.