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Purpose <p><i>Escherichia coli</i> (<i>E.coli</i>) represents the predominant Gram-negative bacterial causing bloodstream infection (BSI) in patients with acute leukemia (AL). This study sought to determine the risk factors for antibiotic-resistant <i>E.coli</i> strains and for 30-day mortality in this specific patient cohort.</p> Methods <p>This retrospective study enrolled adult patients with AL and <i>E.coli</i> BSI hospitalized between January 2017 and December 2023 at Fujian Medical University Union Hospital. Risk factors for antibiotic-resistant <i>E.coli</i> and for 30-day mortality were identified using multivariate logistic regression and Cox proportional hazards regression, respectively, while the Kaplan-Meier method was employed to plot survival curves.</p> Results <p>This study included 127 patients with AL and <i>E.coli</i> BSI. The rates of ESBL-producing <i>E.coli</i> (ESBL-<i>E.coli</i>) and carbapenem-resistant (CR) <i>E.coli</i> were 7.9% and 54.3%, respectively. Multivariate analysis identified prior cephalosporins use as an independent predictor for ESBL-<i>E.coli</i> BSI. The 30-day mortality rate of patients with AL and <i>E.coli</i> BSI was 17.3%. Age, pulmonary infections, CR <i>E.coli</i>, ESBL-<i>E.coli</i>, and inappropriate empirical therapy exhibited higher 30-day mortality rates. Nevertheless, only pulmonary infection and inappropriate empirical therapy were independent risk factors. Consequently, patients with pulmonary infection or receiving inappropriate empirical therapy had a worse prognosis.</p> Conclusions <p>Prior cephalosporins use independently increased the risk of developing ESBL-<i>E.coli</i>. 30-day mortality was independently associated with pulmonary infections and inappropriate empirical therapy. Thus, prompt initiation of appropriate antimicrobial therapy and prevention of pulmonary infection are essential in patients with AL and <i>E.coli</i> BSI.</p>

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Risk factors for antibiotic resistance and 30-day mortality among adult patients with acute leukemia and Escherichia coli bloodstream infection

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Juan Wu,
  • Wei Wang,
  • Kaili Du,
  • Zhongxian Liao,
  • Yawei Shi,
  • Munire Abudumaijiti,
  • Jilai Liu,
  • Jiadi Chen,
  • Xinmiao Fu

摘要

Purpose

Escherichia coli (E.coli) represents the predominant Gram-negative bacterial causing bloodstream infection (BSI) in patients with acute leukemia (AL). This study sought to determine the risk factors for antibiotic-resistant E.coli strains and for 30-day mortality in this specific patient cohort.

Methods

This retrospective study enrolled adult patients with AL and E.coli BSI hospitalized between January 2017 and December 2023 at Fujian Medical University Union Hospital. Risk factors for antibiotic-resistant E.coli and for 30-day mortality were identified using multivariate logistic regression and Cox proportional hazards regression, respectively, while the Kaplan-Meier method was employed to plot survival curves.

Results

This study included 127 patients with AL and E.coli BSI. The rates of ESBL-producing E.coli (ESBL-E.coli) and carbapenem-resistant (CR) E.coli were 7.9% and 54.3%, respectively. Multivariate analysis identified prior cephalosporins use as an independent predictor for ESBL-E.coli BSI. The 30-day mortality rate of patients with AL and E.coli BSI was 17.3%. Age, pulmonary infections, CR E.coli, ESBL-E.coli, and inappropriate empirical therapy exhibited higher 30-day mortality rates. Nevertheless, only pulmonary infection and inappropriate empirical therapy were independent risk factors. Consequently, patients with pulmonary infection or receiving inappropriate empirical therapy had a worse prognosis.

Conclusions

Prior cephalosporins use independently increased the risk of developing ESBL-E.coli. 30-day mortality was independently associated with pulmonary infections and inappropriate empirical therapy. Thus, prompt initiation of appropriate antimicrobial therapy and prevention of pulmonary infection are essential in patients with AL and E.coli BSI.