Bloodstream Infections: High Mortality with Inappropriate Antibiotics - EMJ

Bloodstream Infections: High Mortality with Inappropriate Antibiotics

TIMELY and appropriate antibiotic treatment significantly reduces mortality in patients with haematological malignancies suffering from Klebsiella pneumoniae bloodstream infections, according to a recent study. Bloodstream infections caused by multidrug-resistant organisms, such as Klebsiella pneumoniae, pose a significant challenge in the management of haematological malignancies. Therefore, researchers aimed to analyse the patterns of initial antibiotic therapy, assess the prevalence of resistant strains, identify risk factors, and evaluate factors influencing patient outcomes.  

Conducted at a single centre from January 2017 to December 2020, the retrospective analysis focused on 182 patients with haematological malignancies who developed Klebsiella pneumoniae bloodstream infections. The study found a striking difference in 30-day mortality rates between patients receiving appropriate and inappropriate antibiotic treatments. The 30-day all-cause mortality rate was 30.2% for all patients, with mortality rates of 77.2% in patients who received inappropriate initial treatment compared to only 8.8% in those who received appropriate initial treatment. The study identified inappropriate initial treatment, septic shock, and previous intensive care unit (ICU) stays as key predictors of 30-day mortality. 

Additionally, the data demonstrated a significant association between empirical carbapenem administration and the escalating prevalence of multidrug-resistant K. pneumoniae infections. Polymyxin showcased the highest antimicrobial activity against Klebsiella pneumoniae strains, followed by ticarcillin and imipenem. The study highlighted an upward trend in resistance to antibiotics such as ceftazidime and levofloxacin, emphasizing the need for vigilant antibiotic stewardship.  

This study provides crucial real-world evidence to guide anti-infective treatment for patients with haematological malignancies, empowering healthcare professionals to make more informed clinical decisions and improve patient outcomes in the face of rising multidrug-resistant bacterial infections.  

Katrina Thornber, EMJ


Ma Z et al. High mortality associated with inappropriate initial antibiotic therapy in haematological malignancies with Klebsiella pneumoniae bloodstream infections. Sci Rep. 2024;1DOI:10.1038/s41598-024-63864-5.  

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